1] Université Paris Descartes, Paris, France; Paris Sorbonne Cité, Paris, France [2] Assistance Publique des Hôpitaux de Paris, Service de Gastroentérologie, Hôpital Européen Georges Pompidou, Paris, France.
1] Université François-Rabelais, Paris, France [2] Service d'Hépato-gastroentérologie et de Cancérologie digestive, CHRU de Tours, Paris, France.
Am J Gastroenterol. 2015 Feb;110(2):288-98. doi: 10.1038/ajg.2014.423. Epub 2015 Jan 20.
In Lynch syndrome, flat and diminutive adenomas are particularly prone to malignant transformation, but they can be missed by standard colonoscopy. It is not known whether chromocolonoscopy is able to detect more adenomas than standard colonoscopy in patients with Lynch syndrome.
We conducted a prospective, multicenter, randomized trial to compare standard colonoscopy with standard colonoscopy followed by pancolonic chromoscopy with indigo carmine in patients with a proven germline mutation in a mismatch-repair gene related to Lynch syndrome and who were undergoing screening or surveillance colonoscopy. Standard colonoscopy was used first to detect visible lesions. Colonoscopy with chromoscopy was then performed by a second gastroenterologist (blinded to the findings of the first colonoscopy) to detect additional lesions. The primary end point was the number of patients in whom at least one adenoma was detected.
A total of 78 eligible patients (median age, 45 years) were enrolled at 10 centers from July 2008 to August 2009. Significantly more patients with at least one adenoma were identified by chromocolonoscopy (32/78 (41%)) than by standard colonoscopy (18/78 (23%); P<0.001). The percentage of patients in whom at least one additional adenoma was detected during the chromoscopy was 31% (24/78). Overall, chromocolonoscopy plus colonoscopy detected a total of 55 adenomas in 32 patients (mean number of adenomas detected per patient: 0.7 vs. standard colonoscopy alone: 0.3; P<0.001).
The results support the proposition that chromocolonoscopy may significantly improve the detection rate of colorectal adenomas in patients undergoing screening or surveillance colonoscopy for Lynch syndrome.
在林奇综合征中，扁平且微小的腺瘤特别容易发生恶性转化，但标准结肠镜检查可能会漏诊这些腺瘤。目前尚不清楚在携带与林奇综合征相关的错配修复基因突变的患者中，比色结肠镜检查是否能比标准结肠镜检查发现更多的腺瘤。
我们进行了一项前瞻性、多中心、随机试验，比较了标准结肠镜检查与标准结肠镜检查后行全结肠比色检查联合靛胭脂染色在经证实携带错配修复基因突变的林奇综合征患者中的应用，这些患者正在接受筛查或监测结肠镜检查。首先使用标准结肠镜检查来检测可见病变。然后由第二位胃肠病学家（对第一次结肠镜检查的结果不知情）进行结肠镜检查联合比色检查来检测其他病变。主要终点是至少发现一个腺瘤的患者数量。
2008 年 7 月至 2009 年 8 月，共有 10 个中心的 78 例符合条件的患者（中位年龄 45 岁）入组。比色结肠镜检查（32/78（41%））比标准结肠镜检查（18/78（23%））发现更多患者存在至少一个腺瘤（P<0.001）。在比色检查期间发现至少一个额外腺瘤的患者百分比为 31%（24/78）。总体而言，比色结肠镜检查联合结肠镜检查在 32 例患者中共发现 55 个腺瘤（平均每位患者检测到的腺瘤数量：0.7 个 vs. 标准结肠镜检查：0.3 个；P<0.001）。
这些结果支持这样的观点，即在林奇综合征患者的筛查或监测结肠镜检查中，比色结肠镜检查可能显著提高结直肠腺瘤的检出率。
