Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, Oxford, UK; Oxford National Institute for Health Research Biomedical Research Centre, Oxford, UK; Department of Gastroenterology, Waitemata District Health Board, Auckland, New Zealand.
Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, Oxford, UK; Oxford National Institute for Health Research Biomedical Research Centre, Oxford, UK; Department of Gastroenterology, Alfred Hospital, Melbourne, Australia; Monash University, Melbourne, Australia.
Gastroenterology. 2019 Aug;157(2):462-471. doi: 10.1053/j.gastro.2019.04.014. Epub 2019 Apr 15.
BACKGROUND & AIMS: Adenoma detection rate (ADR) is an important quality assurance measure for colonoscopy. Some studies suggest that narrow-band imaging (NBI) may be more effective at detecting adenomas than white-light endoscopy (WLE) when bowel preparation is optimal. We conducted a meta-analysis of data from individual patients in randomized controlled trials that compared the efficacy of NBI to WLE in detection of adenomas.
We searched MEDLINE, EMBASE, and Cochrane Library databases through April 2017 for randomized controlled trials that assessed detection of colon polyps by high-definition WLE vs NBI and from which data on individual patients were available. The primary outcome measure was ADR adjusted for bowel preparation quality. Multilevel regression models were used with patients nested within trials, and trial included as a random effect.
We collected data from 11 trials, comprising 4491 patients and 6636 polyps detected. Adenomas were detected in 952 of 2251 (42.3%) participants examined by WLE vs 1011 of 2239 (45.2%) participants examined by NBI (unadjusted odds ratio [OR] for detection of adenoma by WLE vs NBI, 1.14; 95% CI, 1.01-1.29; P = .04). NBI outperformed WLE only when bowel preparation was best: adequate preparation OR, 1.07 (95% CI, 0.92-1.24; P = .38) vs best preparation OR, 1.30 (95% CI, 1.04-1.62; P = .02). Second-generation bright NBI had a better ADR than WLE (second-generation NBI OR, 1.28; 95% CI, 1.05-1.56; P = .02), whereas first-generation NBI did not. NBI detected more non-adenomatous polyps than WLE (OR, 1.24; 95% CI, 1.06-1.44; P = .008) and flat polyps than WLE (OR, 1.24; 95% CI, 1.02-1.51; P = .03).
In a meta-analysis of data from individual patients in randomized controlled trials, we found NBI to have a higher ADR than WLE, and that this effect is greater when bowel preparation is optimal.
腺瘤检出率（ADR）是结直肠镜检查的重要质量保证指标。一些研究表明，在肠道准备最佳的情况下，窄带成像（NBI）比白光内镜（WLE）更能有效地检测腺瘤。我们对比较 NBI 与 WLE 检测腺瘤的随机对照试验的个体患者数据进行了荟萃分析。
我们通过 MEDLINE、EMBASE 和 Cochrane 图书馆数据库检索了截至 2017 年 4 月评估高清晰度 WLE 与 NBI 检测结肠息肉的随机对照试验，并获得了个体患者的数据。主要结局指标是根据肠道准备质量调整的 ADR。采用多水平回归模型，将患者嵌套在试验中，并将试验作为随机效应纳入。
我们从 11 项试验中收集了数据，共纳入 4491 名患者和 6636 个息肉。在接受 WLE 检查的 2251 名参与者中，952 名（42.3%）发现了腺瘤，而在接受 NBI 检查的 2239 名参与者中，1011 名（45.2%）发现了腺瘤（未调整的 WLE 与 NBI 检测腺瘤的比值比[OR]，1.14；95%CI，1.01-1.29；P=0.04）。只有当肠道准备最佳时，NBI 才优于 WLE：充分准备 OR，1.07（95%CI，0.92-1.24；P=0.38）与最佳准备 OR，1.30（95%CI，1.04-1.62；P=0.02）。第二代明亮 NBI 的 ADR 优于 WLE（第二代 NBI OR，1.28；95%CI，1.05-1.56；P=0.02），而第一代 NBI 则不然。NBI 比 WLE 检测到更多的非腺瘤性息肉（OR，1.24；95%CI，1.06-1.44；P=0.008）和扁平息肉（OR，1.24；95%CI，1.02-1.51；P=0.03）。
在对随机对照试验的个体患者数据进行的荟萃分析中，我们发现 NBI 的 ADR 高于 WLE，并且在肠道准备最佳时效果更大。
