白光或窄带成像结肠镜检查在溃疡性结肠炎监测中的应用：一项前瞻性多中心研究。
White-Light or Narrow-Band Imaging Colonoscopy in Surveillance of Ulcerative Colitis: A Prospective Multicenter Study.
机构信息
Department of Internal Medicine, Evangelisches Krankenhaus Kalk, Cologne, Germany.
Division of Gastroenterology and Hepatology, Zurich University Hospital, Zurich, Switzerland.
出版信息
Clin Gastroenterol Hepatol. 2015 Oct;13(10):1776-1781.e1. doi: 10.1016/j.cgh.2015.04.172. Epub 2015 May 5.
BACKGROUND & AIMS: Early detection of neoplastic lesions is essential in patients with long-standing ulcerative colitis but the best technique of colonoscopy still is controversial.
METHODS
We performed a prospective multicenter study in patients with long-standing ulcerative colitis. Two colonoscopies were performed in each patient within 3 weeks to 3 months. In white-light (WL) colonoscopy, stepwise random biopsy specimens (4 biopsy specimens every 10 cm), segmental random biopsies (2 biopsy specimens in 5 segments), and targeted biopsy specimens were taken. In NBI colonoscopy, segmental and targeted biopsy specimens were taken. The sequence of WL and NBI colonoscopy was randomized.
RESULTS
In 36 of 159 patients enrolled (22.6%), 54 lesions with intraepithelial neoplasia (IN) were found (51 low-grade, 3 high-grade). In WL colonoscopy we found 11 IN in stepwise biopsy specimens, 4 in segmental biopsy specimens, and 15 in targeted biopsy specimens. In NBI colonoscopy 7 IN were detected in segmental biopsy specimens and 24 IN were detected in targeted biopsy specimens. Almost all IN were found with one technique alone (κ value of WL vs NBI, -0.86; P < .001). Statistically equivalent numbers of IN were found in NBI colonoscopy with targeted and segmental biopsy specimens as in WL colonoscopy with targeted and stepwise biopsy specimens, but with fewer biopsy specimens (11.9 vs 38.6 biopsy specimens, respectively; P < .001), and less withdrawal time was necessary (23 vs 13 min, respectively; P < .001).
CONCLUSIONS
Stepwise biopsy specimens are indispensable in WL colonoscopy. The combination of targeted and segmental biopsy specimens in the NBI technique is as sensitive as targeted together with stepwise biopsy specimens in WL colonoscopy, but requires fewer biopsy specimens and less time. The highest sensitivity should be reached by combining the WL and NBI techniques by switching between the modes.
背景与目的
在患有长期溃疡性结肠炎的患者中，早期发现肿瘤病变至关重要，但最佳的结肠镜检查技术仍存在争议。
方法
我们对患有长期溃疡性结肠炎的患者进行了一项前瞻性多中心研究。每位患者在 3 周到 3 个月内进行了 2 次结肠镜检查。在白光（WL）结肠镜检查中，采用逐步随机活检标本（每 10cm 取 4 个活检标本）、节段随机活检标本（5 个节段中取 2 个活检标本）和靶向活检标本。在 NBI 结肠镜检查中，取节段和靶向活检标本。WL 和 NBI 结肠镜检查的顺序是随机的。
结果
在纳入的 159 例患者中的 36 例（22.6%）中，发现了 54 个上皮内瘤变（IN）病变（51 个低级别，3 个高级别）。在 WL 结肠镜检查中，我们在逐步活检标本中发现了 11 个 IN，在节段活检标本中发现了 4 个，在靶向活检标本中发现了 15 个。在 NBI 结肠镜检查中，在节段活检标本中发现了 7 个 IN，在靶向活检标本中发现了 24 个 IN。几乎所有 IN 都仅通过一种技术发现（WL 与 NBI 的 κ 值为-0.86；P<.001）。与 WL 结肠镜检查中靶向和逐步活检标本相比，NBI 结肠镜检查中靶向和节段活检标本发现的 IN 数量相当，但活检标本较少（分别为 11.9 个和 38.6 个活检标本；P<.001），所需的退镜时间也较短（分别为 23 分钟和 13 分钟；P<.001）。
结论
在 WL 结肠镜检查中，逐步活检标本是不可或缺的。NBI 技术中靶向和节段活检标本的联合与 WL 结肠镜检查中靶向和逐步活检标本的联合一样敏感，但需要的活检标本较少，所需的退镜时间较短。通过在两种模式之间切换来结合 WL 和 NBI 技术，应能达到最高的敏感性。
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