逆行观察设备提高了结直肠镜检查中腺瘤的检出率，适用于监测和诊断性检查。
Retrograde-viewing device improves adenoma detection rate in colonoscopies for surveillance and diagnostic workup.
机构信息
Department of Gastroenterology and Hepatology, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands.
出版信息
World J Gastroenterol. 2012 Jul 14;18(26):3400-8. doi: 10.3748/wjg.v18.i26.3400.
AIM
To determine which patients might benefit most from retrograde viewing during colonoscopy through subset analysis of randomized, controlled trial data.
METHODS
The Third Eye® Retroscope® Randomized Clinical Evaluation (TERRACE) was a randomized, controlled, multicenter trial designed to evaluate the efficacy of a retrograde-viewing auxiliary imaging device that is used during colonoscopy to provide a second video image which allows viewing of areas on the proximal aspect of haustral folds and flexures that are difficult to see with the colonoscope's forward view. We performed a post-hoc analysis of the TERRACE data to determine whether certain subsets of the patient population would gain more benefit than others from use of the device. Subjects were patients scheduled for colonoscopy for screening, surveillance or diagnostic workup, and each underwent same-day tandem examinations with standard colonoscopy (SC) and Third Eye colonoscopy (TEC), randomized to SC followed by TEC or vice versa.
RESULTS
Indication for colonoscopy was screening in 176/345 subjects (51.0%), surveillance after previous polypectomy in 87 (25.2%) and diagnostic workup in 82 (23.8%). In 4 subjects no indication was specified. Previously reported overall results had shown a net additional adenoma detection rate (ADR) with TEC of 23.2% compared to SC. Relative risk (RR) of missing adenomas with SC vs TEC as the initial procedure was 1.92 (P = 0.029). Post-hoc subset analysis shows additional ADRs for TEC compared to SC were 4.4% for screening, 35.7% for surveillance, 55.4% for diagnostic and 40.7% for surveillance and diagnostic combined. The RR of missing adenomas with SC vs TEC was 1.11 (P = 0.815) for screening, 3.15 (P = 0.014) for surveillance, 8.64 (P = 0.039) for diagnostic and 3.34 (P = 0.003) for surveillance and diagnostic combined. Although a multivariate Poisson regression suggested gender as a possibly significant factor, subset analysis showed that the difference between genders was not statistically significant. Age, bowel prep quality and withdrawal time did not significantly affect the RR of missing adenomas with SC vs TEC. Mean sizes of adenomas detected with TEC and SC were similar at 0.59 cm and 0.56 cm, respectively (P = NS).
CONCLUSION
TEC allows detection of significantly more adenomas compared to SC in patients undergoing surveillance or diagnostic workup, but not in screening patients (ClinicalTrials.gov Identifier: NCT01044732).
目的
通过对随机对照试验数据的亚组分析，确定哪些患者可能从结肠镜逆行观察中获益最大。
方法
Third Eye® Retroscope® 随机临床评估（TERRACE）是一项随机、对照、多中心试验，旨在评估一种逆行观察辅助成像设备的疗效，该设备用于结肠镜检查，提供第二个视频图像，允许观察横襞和弯曲近端难以用结肠镜直视观察到的区域。我们对 TERRACE 数据进行了事后分析，以确定该设备是否会使某些患者群体比其他患者群体获益更多。受试者为接受结肠镜检查进行筛查、监测或诊断性检查的患者，每位患者均接受标准结肠镜检查（SC）和 Third Eye 结肠镜检查（TEC）的同日串联检查，随机分为 SC 后接 TEC 或反之。
结果
在 345 名受试者中，176 名（51.0%）的结肠镜检查指征为筛查，87 名（25.2%）为先前息肉切除术后的监测，82 名（23.8%）为诊断性检查。4 名受试者未指定指征。先前报告的总体结果显示，与 SC 相比，TEC 的净腺瘤检出率（ADR）增加了 23.2%。SC 与 TEC 作为初始检查相比，漏诊腺瘤的相对风险（RR）为 1.92（P=0.029）。事后亚组分析显示，与 SC 相比，TEC 额外的 ADR 为筛查 4.4%，监测 35.7%，诊断 55.4%，监测和诊断联合 40.7%。SC 与 TEC 漏诊腺瘤的 RR 为筛查 1.11（P=0.815），监测 3.15（P=0.014），诊断 8.64（P=0.039），监测和诊断联合 3.34（P=0.003）。尽管多变量泊松回归提示性别可能是一个重要的因素，但亚组分析表明，性别之间的差异没有统计学意义。性别、肠道准备质量和撤回时间对 SC 与 TEC 漏诊腺瘤的 RR 没有显著影响。用 TEC 和 SC 检测到的腺瘤的平均大小分别为 0.59 厘米和 0.56 厘米，相似（P=NS）。
结论
在接受监测或诊断性检查的患者中，与 SC 相比，TEC 可显著增加腺瘤的检出率，但在筛查患者中则不然（ClinicalTrials.gov 标识符：NCT01044732）。
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