Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, The Netherlands.
Gastrointest Endosc. 2013 Apr;77(4):542-50. doi: 10.1016/j.gie.2012.11.033. Epub 2013 Jan 23.
The Spigelman classification stratifies cancer risk in familial adenomatous polyposis (FAP) patients with duodenal adenomatosis. High-resolution endoscopy (HRE) and narrow-band imaging (NBI) may identify lesions at high risk.
To compare HRE and NBI for the detection of duodenal and gastric polyps and to characterize duodenal adenomas harboring advanced histology with HRE and NBI.
Prospective, nonrandomized, comparative study. Retrospective image evaluation study.
Tertiary-care center.
Thirty-seven FAP patients undergoing surveillance upper endoscopies.
HRE endoscopy was followed by NBI. The number of gastric polyps and Spigelman staging were compared. Duodenal polyp images were systematically reviewed in a learning and validation phase.
Number of gastric and duodenal polyps detected by HRE and NBI and prevalence of specific endoscopic features in duodenal adenomas with advanced histology.
NBI did not identify additional gastric polyps but detected more duodenal adenomas in 16 examinations, resulting in upgrades of the Spigelman stage in 2 cases (4.4%). Pictures of 168 duodenal adenomas (44% advanced histology) were assessed. In the learning phase, 3 endoscopic features were associated with advanced histology: white color, enlarged villi, and size ≥1 cm. Only size ≥1 cm was confirmed in the validation phase (odds ratio 3.0; 95% confidence interval, 1.2-7.4).
Nonrandomized study, scant number of high-grade dysplasia adenomas.
Inspection with NBI did not lead to a clinically relevant upgrade in the Spigelman classification and did not improve the detection of gastric polyps in comparison with HRE. The only endoscopic feature that predicted advanced histology of a duodenal adenoma was size ≥1 cm.
斯皮格尔曼分类对有十二指肠腺瘤病的家族性腺瘤性息肉病（FAP）患者进行癌症风险分层。高分辨率内镜（HRE）和窄带成像（NBI）可识别高危病变。
比较 HRE 和 NBI 检测十二指肠和胃息肉的情况，并对 HRE 和 NBI 检测到的具有高级别组织学特征的十二指肠腺瘤进行特征描述。
前瞻性、非随机、对照研究。回顾性图像评估研究。
三级医疗中心。
37 例接受监测性上内窥镜检查的 FAP 患者。
进行 HRE 内镜检查后行 NBI。比较胃息肉数量和斯皮格尔曼分期。在学习和验证阶段，对十二指肠息肉图像进行系统回顾。
HRE 和 NBI 检测到的胃和十二指肠息肉数量，以及具有高级别组织学特征的十二指肠腺瘤的特定内镜特征的发生率。
NBI 未发现额外的胃息肉，但在 16 次检查中发现了更多的十二指肠腺瘤，导致 2 例（4.4%）斯皮格尔曼分期升级。评估了 168 个十二指肠腺瘤（44%为高级别组织学）的图像。在学习阶段，有 3 个内镜特征与高级别组织学相关：白色、扩大的绒毛和直径≥1cm。只有在验证阶段才证实了直径≥1cm 这一特征（比值比 3.0；95%置信区间，1.2-7.4）。
非随机研究，高级别异型增生腺瘤数量较少。
与 HRE 相比，NBI 检查并未导致斯皮格尔曼分类的临床相关升级，也未提高胃息肉的检出率。唯一预测十二指肠腺瘤高级别组织学的内镜特征是直径≥1cm。
