Department of Veterans Affairs Medical Center, White River Junction, Vermont, USA; The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.
Indiana University School of Medicine, Department of Medicine, Division of Gastroenterology and Hepatology, Indianapolis, Indiana, USA; Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA.
Gastrointest Endosc. 2019 Mar;89(3):591-598. doi: 10.1016/j.gie.2018.09.046. Epub 2018 Oct 24.
Although water exchange may improve adenoma detection compared with CO, it is unclear whether water is a better medium to fill the lumen during withdrawal and visualize the mucosa. Total underwater colonoscopy (TUC) involves the use of water exchange with the air valve off during insertion followed by the inspection of the mucosa under water. Our goal was to compare miss rates for TUC with standard CO for polyps and adenomas using a tandem colonoscopy design.
We randomized participants to undergo tandem colonoscopies using TUC or CO first. In TUC, water exchange was performed during insertion, and withdrawal was performed under water. For the CO colonoscopy, both insertion and withdrawal were performed with CO. The main outcomes were miss rates for polyps and adenomas for the first examination calculated as the number of additional polyps/adenomas detected during the second examination divided by the total number of polyps/adenomas detected for both examinations. Inspection times were calculated by subtracting the time for polypectomy, and care was taken to keep the times equal for both examinations.
A total of 121 participants were randomized with 61 having CO first. The overall miss rate for polyps was higher for the TUC-first group (81/237; 34%) compared with the CO-first cohort (57/264; 22%) (P = .002). In addition, the overall miss rate for all adenomas was higher for the TUC-first group (52/146; 36%) compared with the CO group (37/159; 23%) (P = .025). However, 1 of the 3 endoscopists had higher polyp/adenoma miss rates for CO, but these were not statistically significant differences. The insertion time was longer for TUC than for CO. After adjusting for times, participant characteristics, and bowel preparation, the miss rate for polyps was higher for TUC than for CO.
We found that TUC had an overall higher polyp and adenoma miss rate than colonoscopy performed with CO, and TUC took longer to perform. However, TUC may benefit some endoscopists, an issue that requires further study. (Clinical trial registration number: NCT03231917.).
虽然与 CO 相比，水交换可能会提高腺瘤的检出率，但尚不清楚在退出时用水填充管腔并观察黏膜是否是更好的方法。全水下结肠镜检查（TUC）涉及在插入时关闭水阀进行水交换，然后在水下检查黏膜。我们的目标是使用串联结肠镜设计比较 TUC 与标准 CO 对息肉和腺瘤的检出率。
我们将参与者随机分为 TUC 或 CO 先行的串联结肠镜检查。在 TUC 中，在插入过程中进行水交换，在退出过程中在水下进行。对于 CO 结肠镜检查，插入和退出均使用 CO 进行。主要结局是计算第一次检查中息肉和腺瘤的漏诊率，即第二次检查中发现的额外息肉/腺瘤数除以两次检查中发现的总息肉/腺瘤数。检查时间通过减去息肉切除术的时间来计算，并注意保持两次检查的时间相等。
共有 121 名参与者被随机分为 CO 先行组（61 名）和 TUC 先行组（60 名）。TUC 先行组（81/237；34%）的总体息肉漏诊率高于 CO 先行组（57/264；22%）（P =.002）。此外，TUC 先行组的所有腺瘤总体漏诊率（52/146；36%）高于 CO 组（37/159；23%）（P =.025）。然而，3 位内镜医生中，有 1 位的 CO 息肉/腺瘤漏诊率较高，但无统计学差异。TUC 的插入时间长于 CO。调整时间、患者特征和肠道准备后，TUC 的息肉漏诊率高于 CO。
我们发现，TUC 的总体息肉和腺瘤漏诊率高于 CO 结肠镜检查，且 TUC 操作时间更长。然而，TUC 可能对某些内镜医生有益，这一问题需要进一步研究。（临床试验注册号：NCT03231917.）。
