Department of Medicine, Mount Sinai St. Luke's-West Hospitals, Icahn School of Medicine, New York, New York, USA.
Division of Gastroenterology, New York VA Harbor Healthcare, NYU School of Medicine, New York, New York, USA.
Gastrointest Endosc. 2018 Aug;88(2):209-222.e11. doi: 10.1016/j.gie.2018.03.022. Epub 2018 Apr 1.
The need to increase the adenoma detection rate (ADR) for colorectal cancer screening has ushered in devices that mechanically or optically improve conventional colonoscopy. Recently, new technology devices (NTDs) have become available. We aimed to compare the ADR, polyp detection rate (PDR), and adenoma miss rate (AMR) between NTDs and conventional colonoscopy and between mechanical and optical NTDs.
MEDLINE and Embase databases were searched from inception through September 2017 for articles or abstracts reporting ADR, PDR, and AMR with NTDs. Randomized controlled trials and case-control studies with >10 subjects were included. Primary outcomes included ADR, PDR, and AMR odds ratio (OR) between conventional colonoscopy and NTDs. Secondary outcomes included cecal intubation rates, adverse events, cecal intubation time, and total colonoscopy time.
From 141 citations, 45 studies with 20,887 subjects were eligible for ≥1 analyses. Overall, the ORs for ADR (1.35; 95% confidence interval [CI] 1.24-1.47; P < .01) and PDR (1.51; 95% CI, 1.37-1.67; P < .01) were higher with NTDs. Higher ADR (OR, 1.52 vs 1.25; P = .035) and PDR (OR, 1.63 vs 1.10; P ≤ .01) were observed with mechanical NTDs. The overall AMR with NTDs was lower compared with conventional colonoscopy (OR, .19; 95% CI, .14-.26; P < .01). Mechanical NTDs had lower AMRs compared with optical NTDs (OR, .10 vs .33; P < .01). No differences in cecal intubation rates, cecal intubation time, or total colonoscopy time were found.
Newer endoscopic technologies are an effective option to improve ADR and PDR and decrease AMR, particularly with mechanical NTDs. No differences in operability and safety were found.
提高结直肠癌筛查的腺瘤检出率（ADR）的需求带来了一些设备，这些设备通过机械或光学手段改善了传统的结肠镜检查。最近，出现了一些新技术设备（NTDs）。我们旨在比较 NTDs 与传统结肠镜检查、机械 NTDs 与光学 NTDs 之间的 ADR、息肉检出率（PDR）和腺瘤漏检率（AMR）。
从 1966 年开始，我们通过 MEDLINE 和 Embase 数据库检索了报告 NTDs 的 ADR、PDR 和 AMR 的文章或摘要。纳入了有>10 名受试者的随机对照试验和病例对照研究。主要结局包括传统结肠镜检查和 NTDs 之间的 ADR、PDR 和 AMR 比值比（OR）。次要结局包括盲肠插管率、不良事件、盲肠插管时间和全结肠镜检查时间。
从 141 篇引文，45 项研究中，20887 名受试者纳入了≥1 项分析。总体而言，NTDs 的 ADR（1.35；95%置信区间 [CI] 1.24-1.47；P<.01）和 PDR（1.51；95% CI，1.37-1.67；P<.01）的 OR 更高。机械 NTDs 的 ADR（OR，1.52 比 1.25；P=.035）和 PDR（OR，1.63 比 1.10；P≤.01）更高。与传统结肠镜检查相比，NTDs 的总体 AMR 较低（OR，.19；95% CI，.14-.26；P<.01）。机械 NTDs 的 AMR 低于光学 NTDs（OR，.10 比.33；P<.01）。盲肠插管率、盲肠插管时间和全结肠镜检查时间无差异。
较新的内镜技术是提高 ADR 和 PDR、降低 AMR 的有效选择，尤其是机械 NTDs。在操作性和安全性方面没有差异。
