Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
Am J Gastroenterol. 2010 Jun;105(6):1301-7. doi: 10.1038/ajg.2010.51. Epub 2010 Feb 23.
Flat and depressed colon neoplasms are an increasingly recognized precursor for colorectal cancer (CRC) in Western populations. High-definition chromoscopy is used to increase the yield of colonoscopy for flat and depressed neoplasms; however, its role in average-risk patients undergoing routine screening remains uncertain.
Average-risk patients referred for screening colonoscopy at four U.S. medical centers were randomized to high-definition chromocolonoscopy or high-definition white light colonoscopy. The primary outcomes, patients with at least one adenoma and the number of adenomas per patient, were compared between the two groups. The secondary outcome was patients with flat or depressed neoplasms, as defined by the Paris classification.
A total of 660 patients were randomized (chromocolonoscopy: 321, white light: 339). Overall, the mean number of adenomas per patient was 1.2+/-2.1, the mean number of flat polyps per patient was 1.4+/-1.9, and the mean number of flat adenomas per patient was 0.5+/-1.0. The number of patients with at least one adenoma (55.5% vs. 48.4%, absolute difference 7.1%, 95% confidence interval (-0.5% to 14.7%), P=0.07), and the number of adenomas per patient (1.3+/-2.4 vs. 1.1+/-1.8, P=0.07) were marginally higher in the chromocolonoscopy group. There were no significant differences in the number of advanced adenomas per patient (0.06+/-0.37 vs. 0.04+/-0.25, P=0.3) and the number of advanced adenomas<10 mm per patient (0.02+/-0.26 vs. 0.01+/-0.14, P=0.4). Two invasive cancers were found, one in each group; neither was a flat neoplasm. Chromocolonoscopy detected significantly more flat adenomas per patient (0.6+/-1.2 vs. 0.4+/-0.9, P=0.01), adenomas<5 mm in diameter per patient (0.8+/-1.3 vs. 0.7+/-1.1, P=0.03), and non-neoplastic lesions per patient (1.8+/-2.3 vs. 1.0+/-1.3, P<0.0001).
High-definition chromocolonoscopy marginally increased overall adenoma detection, and yielded a modest increase in flat adenoma and small adenoma detection, compared with high-definition white light colonoscopy. The yield for advanced neoplasms was similar for the two methods. Our findings do not support the routine use of high-definition chromocolonoscopy for CRC screening in average-risk patients. The high adenoma detection rates observed in this study may be due to the high-definition technology used in both groups.
在西方人群中，平坦和凹陷的结肠肿瘤是结直肠癌（CRC）的一个日益被认识到的前驱病变。高清 chromoscopy 用于增加平坦和凹陷性肿瘤的结肠镜检查产量；然而，其在接受常规筛查的一般风险患者中的作用仍不确定。
在美国四家医疗中心接受筛查性结肠镜检查的一般风险患者被随机分为高清 chromocolonoscopy 或高清白光结肠镜检查。主要结果为至少有一个腺瘤的患者和每个患者的腺瘤数量，在两组之间进行比较。次要结果是根据巴黎分类定义的平坦或凹陷性肿瘤患者。
共有 660 名患者被随机分配（chromocolonoscopy：321 名，白光：339 名）。总体而言，每个患者的平均腺瘤数量为 1.2+/-2.1，每个患者的平均平坦息肉数量为 1.4+/-1.9，每个患者的平均平坦腺瘤数量为 0.5+/-1.0。至少有一个腺瘤的患者比例（55.5% vs. 48.4%，绝对差异 7.1%，95%置信区间（-0.5%至 14.7%），P=0.07）和每个患者的腺瘤数量（1.3+/-2.4 vs. 1.1+/-1.8，P=0.07）在 chromocolonoscopy 组中略高。每个患者的高级腺瘤数量（0.06+/-0.37 vs. 0.04+/-0.25，P=0.3）和每个患者的<10mm 高级腺瘤数量（0.02+/-0.26 vs. 0.01+/-0.14，P=0.4）没有显著差异。发现了 2 例浸润性癌症，每组 1 例；均不是平坦性肿瘤。chromocolonoscopy 检测到每个患者的平坦腺瘤数量显著增加（0.6+/-1.2 vs. 0.4+/-0.9，P=0.01），每个患者的<5mm 直径的腺瘤数量（0.8+/-1.3 vs. 0.7+/-1.1，P=0.03）和每个患者的非肿瘤性病变数量（1.8+/-2.3 vs. 1.0+/-1.3，P<0.0001）。
与高清白光结肠镜检查相比，高清 chromocolonoscopy 略微增加了总体腺瘤的检出率，并适度增加了平坦腺瘤和小腺瘤的检出率。两种方法的高级肿瘤检出率相似。我们的研究结果不支持在一般风险患者中常规使用高清 chromocolonoscopy 进行 CRC 筛查。本研究中观察到的高腺瘤检出率可能是由于两组均使用了高清技术。
