Department of Internal Medicine II, Dr. Horst-Schmidt-Klinik, Wiesbaden, Germany.
Gut. 2011 Apr;60(4):485-90. doi: 10.1136/gut.2010.229534. Epub 2010 Dec 15.
Colonoscopy is the accepted gold standard for detecting colorectal adenomas, but the miss rate, especially for small and flat lesions, remains unacceptably high. The aim of this study was to determine whether enhanced mucosal contrast using pancolonic chromoendoscopy (PCC) allows higher rates of adenoma detection.
In a prospective, randomised two-centre trial, PCC (with 0.4% indigo carmine spraying during continuous extubation) was compared with standard colonoscopy (control group) in consecutive patients attending for routine colonoscopy. The histopathology of the lesions detected was confirmed by evaluating the endoscopic resection or biopsy specimens.
A total of 1008 patients were included (496 in the PCC group, 512 in the control group). The patients' demographic characteristics and indications for colonoscopy were similar in the two groups. The proportion of patients with at least one adenoma was significantly higher in the PCC group (46.2%) than in the control group (36.3%; p = 0.002). Chromoendoscopy increased the overall detection rate for adenomas (0.95 vs 0.66 per patient), flat adenomas (0.56 vs 0.28 per patient) and serrated lesions (1.19 vs 0.49 per patient) (p < 0.001). There was a non-significant trend towards increased detection of advanced adenomas (103 vs 81; p = 0.067). Mean extubation times were slightly but significantly longer in the PCC group in comparison with the control group (11.6 ± 3.36 min vs 10.1 ± 2.03 min; p < 0.001).
Pancolonic chromoendoscopy markedly enhances adenoma detection rates in an average-risk population and is practicable enough for routine application.
结肠镜检查是检测结直肠腺瘤的公认金标准，但漏诊率，尤其是对于小而平坦的病变，仍然高得令人无法接受。本研究旨在确定是否通过全结肠黏膜染色内镜（PCC）增强黏膜对比度可以提高腺瘤的检出率。
在一项前瞻性、随机的双中心试验中，连续入组的接受常规结肠镜检查的患者被分为 PCC 组（在连续灌洗时喷洒 0.4%靛胭脂）和对照组（标准结肠镜组）。通过评估内镜下切除或活检标本的组织病理学来确认所检出病变的病理特征。
共纳入 1008 例患者（PCC 组 496 例，对照组 512 例）。两组患者的人口统计学特征和结肠镜检查指征相似。PCC 组患者中至少检出 1 个腺瘤的比例（46.2%）明显高于对照组（36.3%；p = 0.002）。染色内镜显著提高了腺瘤（0.95 个/例比 0.66 个/例）、平坦腺瘤（0.56 个/例比 0.28 个/例）和锯齿状病变（1.19 个/例比 0.49 个/例）的总体检出率（p < 0.001）。高级别腺瘤的检出率也有升高的趋势（103 例比 81 例；p = 0.067）。与对照组相比，PCC 组的平均拔镜时间略长但差异有统计学意义（11.6 ± 3.36 min 比 10.1 ± 2.03 min；p < 0.001）。
全结肠黏膜染色内镜显著提高了一般风险人群的腺瘤检出率，且实际操作可行，足以常规应用。
