Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA.
Am J Gastroenterol. 2012 Mar;107(3):363-70; quiz 371. doi: 10.1038/ajg.2011.436. Epub 2011 Dec 20.
Colonoscopy has an appreciable miss rate for adenomas and colorectal cancer. The goal of advanced endoscopic imaging is to improve lesion detection. Compared with standard definition, high-definition (HD) colonoscopes have the advantage of increased field of visualization and higher resolution; narrow band imaging (NBI) utilizes narrow band filters for enhanced visualization of surface architecture and capillary pattern. The objective of this study was to compare the yield and miss rates of HD-NBI and HD-WLE (white light endoscopy) for the detection of colon polyps using meta-analysis.
A recursive literature search of randomized controlled trials (RCTs) comparing the yield of HD-NBI and HD-WLE for detection of colon polyps in patients undergoing screening/surveillance colonoscopy. Authors were contacted for missing data. In RCT with tandem colonoscopy (RCT-t), findings from the first-pass examinations were used in the yield analysis and from the tandem pass for the miss rate analysis. Data on the yield of polyps were extracted, pooled, and analyzed using RevMan 4.2.9 software. Odds ratio (OR) and 95% confidence intervals (CIs) for the pooled data for the yield and miss rates of NBI and WLE were calculated. A fixed effect model (FEM) was used for analyses without, and a random effect model (REM) for analyses with heterogeneity.
The yield analysis revealed no significant difference between HD-NBI and HD-WLE for the detection of adenomas (six studies; n=2,284; OR: 1.01; CI: 0.74-1.37; REM); patients with polyps (six studies; n=2,275; OR: 1.15; CI: 0.8-1.64; REM); patients with adenomas (four studies; n=2,177; OR: 1.0; CI: 0.83-1.20; FEM); detection of adenomas <10 mm (five studies; n=1,618; OR: 1.32; CI: 0.92-1.88; FEM); flat adenomas (five studies; n=1,675; OR: 1.26; CI: 0.62-2.57; REM); and flat adenomas per patient (five studies; n=2,200; OR: 1.63; CI: 0.71-3.74; REM). The miss rate analysis revealed no difference in polyp miss rate (three studies; n=524; OR: 1.17; CI: 0.8-1.71; FEM) or adenoma miss rate (three studies; n=524; OR: 0.65; CI: 0.4-1.06; FEM) between the two techniques.
Compared with HD-WLE, HD-NBI does not increase the yield of colon polyps, adenomas, or flat adenomas, nor does it decrease the miss rate of colon polyps or adenomas in patients undergoing screening/surveillance colonoscopy.
结肠镜检查对腺瘤和结直肠癌的检出率存在显著漏诊。先进内镜成像的目标是提高病变检出率。与标准定义相比，高清（HD）结肠镜具有增加视野和提高分辨率的优势；窄带成像（NBI）利用窄带滤波器增强表面结构和毛细血管模式的可视化。本研究旨在通过荟萃分析比较 HD-NBI 和 HD-WLE（白光内镜）在检测结直肠息肉方面的检出率和漏诊率。
对比较筛查/监测结肠镜检查中 HD-NBI 和 HD-WLE 检测结直肠息肉的检出率的随机对照试验（RCT）进行递归文献检索。作者联系了缺失数据的作者。在串联结肠镜检查 RCT（RCT-t）中，第一遍检查的结果用于检出率分析，第二遍检查的结果用于漏诊率分析。提取、汇总并使用 RevMan 4.2.9 软件分析息肉检出率的数据。计算 NBI 和 WLE 检出率和漏诊率的汇总数据的比值比（OR）和 95%置信区间（CI）。无异质性时使用固定效应模型（FEM）进行分析，有异质性时使用随机效应模型（REM）进行分析。
在检测腺瘤（六项研究；n=2284；OR：1.01；CI：0.74-1.37；REM）、有息肉的患者（六项研究；n=2275；OR：1.15；CI：0.8-1.64；REM）、有腺瘤的患者（四项研究；n=2177；OR：1.0；CI：0.83-1.20；FEM）、检出<10mm 的腺瘤（五项研究；n=1618；OR：1.32；CI：0.92-1.88；FEM）、平坦型腺瘤（五项研究；n=1675；OR：1.26；CI：0.62-2.57；REM）和每位患者的平坦型腺瘤（五项研究；n=2200；OR：1.63；CI：0.71-3.74；REM）方面，HD-NBI 与 HD-WLE 的检出率无显著差异。在息肉漏诊率（三项研究；n=524；OR：1.17；CI：0.8-1.71；FEM）或腺瘤漏诊率（三项研究；n=524；OR：0.65；CI：0.4-1.06；FEM）方面，两种技术之间也无差异。
与 HD-WLE 相比，HD-NBI 不会增加结直肠息肉、腺瘤或平坦型腺瘤的检出率，也不会降低筛查/监测结肠镜检查中结直肠息肉或腺瘤的漏诊率。
