Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Dig Endosc. 2015 Jan;27(2):223-31. doi: 10.1111/den.12382. Epub 2014 Nov 17.
Colonoscopy is the criterion standard for detecting colorectal adenomas and cancers. However, multiple studies have reported a significant percentage of adenomas are missed during standard, forward-viewing colonoscopy. Missed adenomas can lead to interval colorectal cancers. Aside from inadequate colon preparation, incomplete examinations (e.g. failure to intubate the cecum), short withdrawal times, and patient-related factors, the primary reason for missing colorectal adenomas and early cancers is poor visualization of the proximal aspect of colonic folds, at anatomical flexures, and in the ileocecal valve area. These anatomical sites tend to be hidden from the standard forward-viewing colonoscope (170-degree angle of view) and can often only be seen through manipulation of the colonoscope by the endoscopist. Thus, there is mounting evidence supporting the need to reduce the adenoma 'miss rate' of standard forward-viewing colonoscopy by improving upon current colonoscope technology and its current visualization/optics limitations. Recently, there are a number of emerging technologies that may help revolutionize how colonoscopy is carried out and that will significantly reduce adenoma miss rates. These include the Third Eye® Retroscope® and Third Eye® Panoramic(TM) (Avantis Medical Systems, Sunnyvale, CA, USA); Fuse® Full Spectrum Endoscopy® colonoscopy platform (EndoChoice Inc., Alpharetta, GA, USA); Extra-Wide-Angle-View colonoscope (Olympus, Tokyo, Japan), and the NaviAid(TM) G-EYE(TM) balloon colonoscope (SMART Medical Systems Ltd, Ra'anana, Israel).
结肠镜检查是检测结直肠腺瘤和癌症的金标准。然而,多项研究报告称,在标准的前视结肠镜检查中,有相当大比例的腺瘤被遗漏。遗漏的腺瘤可能导致结直肠间隔期癌症。除了肠道准备不充分、检查不完整(例如未能插管盲肠)、退镜时间短以及患者相关因素外,遗漏结直肠腺瘤和早期癌症的主要原因是结肠褶皱的近端、解剖弯曲处和回盲瓣区域的可视化效果不佳。这些解剖部位往往隐藏在标准的前视结肠镜(170 度视角)之外,通常只能通过内镜医生操纵结肠镜才能看到。因此,越来越多的证据支持需要通过改进现有结肠镜技术及其当前的可视化/光学限制来降低标准前视结肠镜检查的腺瘤“漏诊率”。最近,有许多新兴技术可能有助于彻底改变结肠镜检查的方式,并显著降低腺瘤的漏诊率。这些技术包括 Third Eye® Retroscope® 和 Third Eye® Panoramic(TM)(Avantis Medical Systems,美国加利福尼亚州森尼韦尔);Fuse® Full Spectrum Endoscopy® 结肠镜检查平台(EndoChoice Inc.,美国佐治亚州阿尔法利塔);Extra-Wide-Angle-View 结肠镜(Olympus,日本东京)和 NaviAid(TM) G-EYE(TM) 球囊结肠镜(SMART Medical Systems Ltd.,以色列拉阿纳纳)。