Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.
Gastroenterology Department, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain.
Gut. 2018 Jan;67(1):70-78. doi: 10.1136/gutjnl-2016-312332. Epub 2016 Sep 9.
Outside clinical trials, the effectiveness of chromoendoscopy (CE) for long-standing IBD surveillance is controversial. We aimed to assess the effectiveness of CE for neoplasia detection and characterisation, in real-life.
From June 2012 to 2014, patients with IBD were prospectively included in a multicentre cohort study. Each colonic segment was evaluated with white light followed by 0.4% indigo carmine CE. Specific lesions' features were recorded. Optical diagnosis was assessed. Dysplasia detection rate between expert and non-expert endoscopists and learning curve were ascertained.
Ninety-four (15.7%) dysplastic (1 cancer, 5 high-grade dysplasia, 88 low-grade dysplasia) and 503 (84.3%) non-dysplastic lesions were detected in 350 patients (47% female; mean disease duration: 17 years). Colonoscopies were performed with standard definition (41.5%) or high definition (58.5%). Dysplasia miss rate with white light was 40/94 (57.4% incremental yield for CE). CE-incremental detection yield for dysplasia was comparable between standard definition and high definition (51.5% vs 52.3%, p=0.30). Dysplasia detection rate was comparable between expert and non-expert (18.5% vs 13.1%, p=0.20). No significant learning curve was observed (8.2% vs 14.2%, p=0.46). Sensitivity, specificity, and positive and negative predictive values for dysplasia optical diagnosis were 70%, 90%, 58% and 94%, respectively. Endoscopic characteristics predictive of dysplasia were: proximal location, loss of innominate lines, polypoid morphology and Kudo pit pattern III-V.
CE presents a high diagnostic yield for neoplasia detection, irrespectively of the technology and experience available in any centre. In vivo, CE optical diagnosis is highly accurate for ruling out dysplasia, especially in expert hands. Lesion characteristics can aid the endoscopist for in situ therapeutic decisions.
NCT02543762.
在临床试验之外， chromoendoscopy（CE）在长期 IBD 监测中的有效性存在争议。我们旨在评估 CE 在实际中对肿瘤检测和特征描述的有效性。
从 2012 年 6 月至 2014 年，前瞻性地将 IBD 患者纳入多中心队列研究。每段结肠均用白光和 0.4%靛胭脂 CE 进行评估。记录特定病变的特征。评估光学诊断。确定专家和非专家内镜医师之间的息肉检出率和学习曲线。
在 350 例患者（47%为女性；平均疾病病程：17 年）中检测到 94 例（15.7%）异型增生（1 例癌症，5 例高级别异型增生，88 例低级别异型增生）和 503 例（84.3%）非异型增生病变。结肠镜检查采用标准定义（41.5%）或高清定义（58.5%）。白光下异型增生的漏诊率为 40/94（CE 增量诊断率为 57.4%）。标准定义和高清定义之间的 CE 增量检测对异型增生的检出率无差异（51.5% vs 52.3%，p=0.30）。专家和非专家之间的异型增生检出率无差异（18.5% vs 13.1%，p=0.20）。未观察到明显的学习曲线（8.2% vs 14.2%，p=0.46）。异型增生光学诊断的敏感性、特异性、阳性和阴性预测值分别为 70%、90%、58%和 94%。预测异型增生的内镜特征是：近端位置、无名线丧失、息肉样形态和 Kudo pit 模式 III-V。
CE 对肿瘤的检测具有较高的诊断率，无论中心采用何种技术和经验。在体内，CE 光学诊断对排除异型增生具有高度准确性，尤其是在专家手中。病变特征有助于内镜医师做出原位治疗决策。
NCT02543762。
