染色内镜检查与标准结肠镜检查在炎症性肠病患者中检测非息肉样发育异常的比较。

Chromoendoscopy versus standard colonoscopy for detection of nonpolypoid dysplasia in patients with inflammatory bowel disease.

作者信息

Sekra Anurag, Schauer Cameron, Mills Lucy, Vandal Alain C, Rose Toby, Lal Dinesh, Ogra Ravinder

机构信息

FRACP Consultant Gastroenterologist, Middlemore Hospital, Counties Manukau District Health Board, Auckland.

Gastroenterology Registrar, Middlemore Hospital, Counties Manukau District Health Board, Auckland.

出版信息

N Z Med J. 2018 Jul 13;131(1478):32-38.

PMID:30001304

Abstract

AIM

Inflammatory bowel disease (IBD) is associated with an increased risk of colorectal cancer. Studies show that chromoendoscopy (CE) can increase the detection of dysplasia at surveillance colonoscopy, compared to standard white light endoscopy (WLE). We performed a retrospective cohort study to compare standard WLE to CE with targeted biopsies in detecting nonpolypoid dysplasia in IBD patients undergoing surveillance colonoscopy at a single tertiary centre.

METHOD

Data was collected on 110 consecutive patients with IBD who underwent surveillance colonoscopy from 1 August 2015 to 31 July 2017 at Counties Manukau District Health Board, Auckland. Patients had either WLE or CE. Patient characteristics, endoscopic and histologic descriptions were reviewed. Rates of dysplasia detection by the different endoscopic techniques were compared using an exact Poisson test.

RESULTS

76/110 (69%) had WLE (mean age 56y; median disease duration 18y) and 34/110 (31%) had CE (median age 59y; median disease duration 19y). Nonpolypoid dysplasia was detected in 0/76 (0%) patients who had WLE. Seven nonpolypoid dysplastic lesions were detected in 4/34 (11.8%) patients who had CE. Dysplasia pick up rate was significantly higher in the CE group with a risk difference of 11.8%, 95% confidence interval (0.93, 22.59), p=0.008. Dysplasia detection rate per patient was also significantly higher in the CE group with a rate difference of 20.6 lesions per 100 patients, 95% confidence interval (5.3, 35.8), p=0.0003. As expected, there was no difference between the number of polypoid dysplastic lesions found between the two groups (p=0.12).

CONCLUSION

In our cohort of IBD patients undergoing surveillance colonoscopy, CE with targeted biopsy is associated with a significantly increased nonpolypoid dysplasia detection rate when compared to WLE. These results are comparable to studies performed in the rest of the world.

摘要

目的

炎症性肠病（IBD）与结直肠癌风险增加相关。研究表明，与标准白光内镜检查（WLE）相比，染色内镜检查（CE）可提高监测性结肠镜检查中发育异常的检出率。我们进行了一项回顾性队列研究，以比较在单一三级中心接受监测性结肠镜检查的IBD患者中，标准WLE与CE联合靶向活检在检测非息肉样发育异常方面的效果。

方法

收集了2015年8月1日至2017年7月31日在奥克兰马努考县地区卫生委员会接受监测性结肠镜检查的110例连续IBD患者的数据。患者接受了WLE或CE检查。回顾了患者特征、内镜和组织学描述。使用精确泊松检验比较不同内镜技术的发育异常检出率。

结果

110例患者中，76例（69%）接受了WLE（平均年龄56岁；疾病中位病程18年），34例（31%）接受了CE（中位年龄59岁；疾病中位病程19年）。接受WLE的患者中，0/76（0%）检测到非息肉样发育异常。接受CE的患者中，4/34（11.8%）检测到7个非息肉样发育异常病变。CE组的发育异常检出率显著更高，风险差异为11.8%，95%置信区间（0.93，22.59），p = 0.008。CE组每例患者的发育异常检出率也显著更高，率差为每100例患者20.6个病变，95%置信区间（5.3，35.8），p = 0.0003。正如预期的那样，两组间发现的息肉样发育异常病变数量没有差异（p = 0.12）。