Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Gastrointest Endosc. 2017 Aug;86(2):376-385.e2. doi: 10.1016/j.gie.2016.12.025. Epub 2017 Jan 6.
The Third Eye Retroscope, Full Spectrum Endoscope (FUSE), and EndoRings devices have been shown to reduce overall adenoma miss rates. We evaluated the characteristics of adenomas and patient subgroups for which these behind-folds visualizing technologies mostly reduce adenoma miss rates.
Data of 3 multicenter randomized trials (NCT01044732, NCT01549535, NCT01955122) were combined. Patients underwent same-day, back-to-back tandem examinations with standard colonoscopy and Third Eye Retroscope, FUSE, or EndoRings colonoscopy, respectively. Adenoma miss rates were stratified by adenoma characteristics and patient subgroups.
A total of 650 patients (60% male, mean age 57.5 years, standard deviation 9.7 years) were included; 330 patients underwent behind-folds visualizing colonoscopy first, and 320 patients underwent standard colonoscopy first. Regarding adenoma characteristics, adenoma miss rates were significantly (P < .001) lower with behind-folds visualizing technologies compared with standard colonoscopy for proximal (14% vs 38%) and distal (15% vs 35%), ≤5 mm (17% vs 38%), 6 to 9 mm (8% vs 44%), sessile (16% vs 37%), flat (9% vs 52%; P = .014), and tubular (15% vs 38%) adenomas and sessile serrated polyps (7% vs 50%; P = .039) but were not statistically significantly (P > .05) different for ≥10 mm, pedunculated, (tubulo-)villous, and advanced adenomas. Regarding patient subgroups, adenoma miss rates were significantly (P ≤ .020) lower with behind-folds visualizing technologies for patients ≥50 years, both sexes, and all indications.
Behind-folds visualizing colonoscopy reduces miss rates for 1 to 9 mm adenomas in the entire colon, whereas no advantage was found for ≥10 mm and advanced adenomas. Whether increased detection and removal of <10 mm adenomas also reduces colorectal cancer incidence and mortality remains to be determined. Future research is needed to determine which colonoscopy technology would be most beneficial for which patient or endoscopist.
第三只眼 Retroscope、全谱内镜（FUSE）和 EndoRings 设备已被证明可降低整体腺瘤检出率。我们评估了这些褶皱内可视化技术主要降低腺瘤检出率的腺瘤特征和患者亚组的特征。
合并了 3 项多中心随机试验（NCT01044732、NCT01549535、NCT01955122）的数据。患者分别接受同日、背靠背串联的标准结肠镜检查和第三只眼 Retroscope、FUSE 或 EndoRings 结肠镜检查。根据腺瘤特征和患者亚组分层腺瘤检出率。
共纳入 650 例患者（60%为男性，平均年龄 57.5 岁，标准差 9.7 岁）；330 例患者首先进行褶皱内可视化结肠镜检查，320 例患者首先进行标准结肠镜检查。关于腺瘤特征，与标准结肠镜相比，褶皱内可视化技术对近端（14% vs 38%）和远端（15% vs 35%）、≤5mm（17% vs 38%）、6-9mm（8% vs 44%）、无蒂（16% vs 37%）、平坦（9% vs 52%；P=0.014）和管状（15% vs 38%）腺瘤和无蒂锯齿状息肉（7% vs 50%；P=0.039）的腺瘤检出率显著（P<0.001）降低，但对≥10mm、有蒂、（管状-绒毛状）和高级别腺瘤的腺瘤检出率无统计学意义（P>0.05）。关于患者亚组，褶皱内可视化技术对≥50 岁、男女和所有适应证的患者的腺瘤检出率显著（P≤0.020）降低。
褶皱内可视化结肠镜检查可降低整个结肠 1-9mm 腺瘤的检出率，而对≥10mm 和高级别腺瘤则无优势。增加对<10mm 腺瘤的检出和切除是否也能降低结直肠癌的发病率和死亡率，仍有待确定。需要进一步的研究来确定哪种结肠镜技术对哪种患者或内镜医生最有益。
