Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA.
Department of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas, USA; Department of Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, Missouri, USA.
Gastrointest Endosc. 2019 Nov;90(5):721-731.e1. doi: 10.1016/j.gie.2019.06.041. Epub 2019 Jul 6.
The evidence for modification of conventional colonoscopy using either "distal attachments" (DAs; endocap, endocuff, and endoring) or "electronic chromoendoscopy" (EC; narrow-band imaging [NBI], iScan, blue-light imaging, autofluorescence imaging, and linked-color imaging) to improve the detection of serrated adenomas during colonoscopy has shown conflicting results.
A comprehensive literature search was performed using Medline, Google Scholar, Embase, and Cochrane Library based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Randomized controlled trials (RCTs) comparing any DA or EC with high-definition white-light colonoscopy for detection of serrated adenomas (sessile serrated adenoma/polyp and traditional serrated adenoma) were included. The primary outcome was serrated adenoma detection rate (SADR) defined as the number of patients with at least 1 serrated adenoma of total patients in that group. The secondary outcome was the number of serrated adenomas per subject. Pooled rates were reported using risk ratio (RR) with 95% confidence interval.
Seventeen studies with 13,631 patients (56% men; age range, 50-66 years) met the inclusion criteria. The use of DAs (RR, 1.21; P = .45) and EC (RR, 1.29; P = .09) during colonoscopy did not show a significant improvement in SADR. The SADR using EC was 6.9% (4 studies) and that with NBI alone was 3.7% (3 studies).
The results indicate that, except for NBI, the use of DAs or EC during colonoscopy does not improve detection of serrated adenomas in the colon. More RCTs evaluating NBI are needed to explore the effect.
使用“远端附件”（DA；内镜套圈、内镜套囊和内镜环）或“电子染色内镜”（EC；窄带成像[NBI]、iScan、蓝光成像、自体荧光成像和链接色成像）来改进结肠镜检查中锯齿状腺瘤的检测，其证据存在矛盾。
根据系统评价和荟萃分析的首选报告项目，使用 Medline、Google Scholar、Embase 和 Cochrane Library 进行全面文献检索。纳入比较任何 DA 或 EC 与高清白光结肠镜检查检测锯齿状腺瘤（无蒂锯齿状腺瘤/息肉和传统锯齿状腺瘤）的随机对照试验（RCT）。主要结局为锯齿状腺瘤检出率（SADR），定义为该组中至少有 1 例锯齿状腺瘤的患者总数。次要结局为每位患者的锯齿状腺瘤数量。使用风险比（RR）和 95%置信区间报告汇总率。
符合纳入标准的 17 项研究共纳入 13631 例患者（56%为男性；年龄范围 50-66 岁）。结肠镜检查中使用 DA（RR，1.21；P=.45）和 EC（RR，1.29；P=.09）并未显著提高 SADR。EC 的 SADR 为 6.9%（4 项研究），NBI 单独使用的 SADR 为 3.7%（3 项研究）。
结果表明，除 NBI 外，结肠镜检查中使用 DA 或 EC 并不能提高结直肠锯齿状腺瘤的检出率。需要更多评估 NBI 的 RCT 来探索其效果。
