East James E, Vleugels Jasper L, Roelandt Philip, Bhandari Pradeep, Bisschops Raf, Dekker Evelien, Hassan Cesare, Horgan Gareth, Kiesslich Ralf, Longcroft-Wheaton Gaius, Wilson Ana, Dumonceau Jean-Marc
Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, United Kingdom.
Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
Endoscopy. 2016 Nov;48(11):1029-1045. doi: 10.1055/s-0042-118087. Epub 2016 Oct 6.
This technical review is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). It addresses the utilization of advanced endoscopic imaging in gastrointestinal (GI) endoscopy. This technical review is based on a systematic literature search to evaluate the evidence supporting the use of advanced endoscopic imaging throughout the GI tract. Technologies considered include narrowed-spectrum endoscopy (narrow band imaging [NBI]; flexible spectral imaging color enhancement [FICE]; i-Scan digital contrast [I-SCAN]), autofluorescence imaging (AFI), and confocal laser endomicroscopy (CLE). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was adopted to define the strength of recommendation and the quality of evidence. We suggest advanced endoscopic imaging technologies improve mucosal visualization and enhance fine structural and microvascular detail. Expert endoscopic diagnosis may be improved by advanced imaging, but as yet in community-based practice no technology has been shown consistently to be diagnostically superior to current practice with high definition white light. (Low quality evidence.) We recommend the use of validated classification systems to support the use of optical diagnosis with advanced endoscopic imaging in the upper and lower GI tracts (strong recommendation, moderate quality evidence). We suggest that training improves performance in the use of advanced endoscopic imaging techniques and that it is a prerequisite for use in clinical practice. A learning curve exists and training alone does not guarantee sustained high performances in clinical practice. (Weak recommendation, low quality evidence.) Advanced endoscopic imaging can improve mucosal visualization and endoscopic diagnosis; however it requires training and the use of validated classification systems.
本技术综述是欧洲胃肠内镜学会（ESGE）的官方声明。它探讨了先进内镜成像技术在胃肠（GI）内镜检查中的应用。本技术综述基于系统的文献检索，以评估支持在整个胃肠道使用先进内镜成像技术的证据。所考虑的技术包括窄谱内镜检查（窄带成像[NBI]；灵活光谱成像色彩增强[FICE]；i-Scan数字造影[I-SCAN]）、自体荧光成像（AFI）和共聚焦激光显微内镜检查（CLE）。采用推荐分级评估、制定与评价（GRADE）系统来界定推荐强度和证据质量。我们认为先进的内镜成像技术可改善黏膜可视化，并增强细微结构和微血管细节。先进成像技术可能会改善内镜专家的诊断，但在基于社区的实践中，目前尚无技术始终被证明在诊断上优于当前的高清白光检查（低质量证据）。我们建议使用经过验证的分类系统，以支持在上下胃肠道使用先进内镜成像技术进行光学诊断（强烈推荐，中等质量证据）。我们认为培训可提高先进内镜成像技术的使用水平，且培训是临床实践应用的先决条件。存在学习曲线，仅靠培训并不能保证在临床实践中持续保持高水平表现（弱推荐，低质量证据）。先进的内镜成像技术可改善黏膜可视化和内镜诊断；然而，它需要培训并使用经过验证的分类系统。
