Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, , Seoul, Republic of Korea.
Gut. 2014 May;63(5):785-91. doi: 10.1136/gutjnl-2013-304578. Epub 2013 Jul 12.
Virtual chromoendoscopy (CE) is expected to enhance adenoma yield and reduce variation in performance between colonoscopists. This study aimed to compare the efficacy of narrow band imaging (NBI), flexible spectral imaging CE (FICE) and white light (WL) colonoscopy and their impact for less experienced endoscopists.
We performed a randomised tandem colonoscopy trial controlling for withdrawal time and bowel preparation. Average-risk adults undergoing screening colonoscopy were enrolled and randomly assigned to first withdrawal with one of the three imaging modalities (NBI (NBI-WL group), FICE (FICE-WL group) and WL (WL-WL group)). Eight colonoscopists were categorised into expert and non-expert subgroups.
1650 subjects (mean age 51.4 years, 63.9% men) were included (550 in each group). Compared with WL, neither NBI nor FICE increased the mean number of adenomas detected per patient (0.37 vs 0.35 and 0.36; p=0.591) or the percentage of patients with adenoma (25.3% vs 24.5% and 23.6%; p=0.753). For all three modalities, expert subgroups had higher yields of adenomas than non-expert subgroups. Learning curves were observed only for non-expert subgroups with all three modalities. The percentage of missed adenomas did not differ between the three groups (20.8% by WL vs 22.9% by NBI and 26.0% by FICE, p=0.300) and was not affected by endoscopists' expertise.
Neither NBI nor FICE improved adenoma detection or miss rates, with no difference in diagnostic efficacy between the two systems. Virtual CE had no additional benefits over WL for non-experts.
KCT0000570.
虚拟染色内镜（CE）有望提高腺瘤检出率并降低内镜医师之间操作的差异性。本研究旨在比较窄带成像（NBI）、柔性光谱成像 CE（FICE）和白光（WL）结肠镜检查的效果，并评估其对经验不足的内镜医师的影响。
我们进行了一项随机平行结肠镜检查试验，同时控制退镜时间和肠道准备情况。招募了接受筛查性结肠镜检查的平均风险成年人，并将其随机分为三组，分别进行首次退镜检查：NBI（NBI-WL 组）、FICE（FICE-WL 组）和 WL（WL-WL 组）。8 名内镜医师被分为专家和非专家亚组。
共纳入 1650 例受试者（平均年龄 51.4 岁，63.9%为男性），每组 550 例。与 WL 相比，NBI 和 FICE 均未增加每位患者的平均腺瘤检出数（0.37 对 0.35，p=0.591；0.36 对 0.35，p=0.591）或腺瘤检出率（25.3%对 24.5%，p=0.753；23.6%对 24.5%，p=0.753）。对于所有三种方法，专家亚组的腺瘤检出率均高于非专家亚组。仅在所有三种方法的非专家亚组中观察到学习曲线。三组之间的漏诊腺瘤百分比无差异（WL 组为 20.8%，NBI 组为 22.9%，FICE 组为 26.0%，p=0.300），且不受内镜医师专业水平的影响。
NBI 和 FICE 均未提高腺瘤检出率或漏诊率，两种系统的诊断效果无差异。对于非专家，虚拟 CE 相较于 WL 并无额外获益。
KCT0000570。
