随机对照试验研究标准白光、高清白光和窄带成像结肠镜检查对结肠息肉的检出率和预测息肉组织学的作用。
Randomized, controlled trial of standard-definition white-light, high-definition white-light, and narrow-band imaging colonoscopy for the detection of colon polyps and prediction of polyp histology.
机构信息
University of Kansas School of Medicine, Veterans Affairs Medical Center, Kansas City, Missouri 64128-2295, USA.
出版信息
Gastrointest Endosc. 2011 Sep;74(3):593-602. doi: 10.1016/j.gie.2011.04.050. Epub 2011 Jul 29.
BACKGROUND
Missing adenomas and the inability to accurately differentiate between polyp histology remain the main limitations of standard-definition white-light (SD-WL) colonoscopy.
OBJECTIVE
To compare the adenoma detection rates of SD-WL with those of high-definition white-light (HD-WL) and narrow-band imaging (NBI) as well as the accuracy of predicting polyp histology.
DESIGN
Multicenter, prospective, randomized, controlled trial.
SETTING
Two academic medical centers in the United States.
PATIENTS
Subjects undergoing screening or surveillance colonoscopy.
INTERVENTION
Subjects were randomized to undergo colonoscopy with one of the following: SD-WL, HD-WL, or NBI.
MAIN OUTCOME MEASUREMENTS
The proportion of subjects detected with adenomas, adenomas detected per subject, and the accuracy of predicting polyp histology real time.
RESULTS
A total of 630 subjects were included. The proportion of subjects with adenomas was 38.6% with SD-WL compared with 45.7% with HD-WL and 46.2% with NBI (P = .17 and P = .14, respectively). Adenomas detected per subject were 0.69 with SD-WL compared with 1.12 with HD-WL and 1.13 with NBI (P = .016 and P = .014, respectively). HD-WL and NBI detected more subjects with flat and right-sided adenomas compared with SD-WL (all P values <.005). NBI had a superior sensitivity (90%) and accuracy (82%) to predict adenomas compared with SD-WL and HD-WL (all P values <.005).
LIMITATIONS
Academic medical centers with experienced endoscopists.
CONCLUSIONS
There was no difference in the proportion of subjects with adenomas detected with SD-WL, HD-WL, and NBI. However, HD-WL and NBI detected significantly more adenomas per subject (>60%) compared with SD-WL. NBI had the highest accuracy in predicting adenomas in real time during colonoscopy. (
CLINICAL TRIAL REGISTRATION NUMBER
NCT 00614770.).
背景
标准白光（SD-WL）结肠镜检查仍然存在腺瘤遗漏和无法准确区分息肉组织学的问题。
目的
比较 SD-WL 与高清白光（HD-WL）和窄带成像（NBI）的腺瘤检出率以及预测息肉组织学的准确性。
设计
多中心、前瞻性、随机、对照试验。
地点
美国的两个学术医疗中心。
患者
接受筛查或监测结肠镜检查的患者。
干预
患者随机接受以下一种方式的结肠镜检查：SD-WL、HD-WL 或 NBI。
主要观察指标
检测到腺瘤的患者比例、每位患者检测到的腺瘤数量以及实时预测息肉组织学的准确性。
结果
共纳入 630 例患者。SD-WL 组发现腺瘤的患者比例为 38.6%，HD-WL 组为 45.7%，NBI 组为 46.2%（P =.17 和 P =.14）。每位患者检测到的腺瘤数量分别为 0.69 个，1.12 个和 1.13 个（P =.016 和 P =.014）。与 SD-WL 相比，HD-WL 和 NBI 检测到更多的平坦和右侧腺瘤患者（所有 P 值均<.005）。NBI 预测腺瘤的敏感性（90%）和准确性（82%）优于 SD-WL 和 HD-WL（所有 P 值均<.005）。
局限性
在经验丰富的内镜医生所在的学术医疗中心进行。
结论
SD-WL、HD-WL 和 NBI 检测到的腺瘤患者比例没有差异。然而，HD-WL 和 NBI 检测到的每位患者的腺瘤数量明显更多（>60%）。NBI 在结肠镜检查实时预测腺瘤方面具有最高的准确性。（临床试验注册号：NCT 00614770）。
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