Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
Digestion. 2020;101(5):563-570. doi: 10.1159/000501476. Epub 2019 Jul 16.
Duodenal cancer is one of the extracolonic malignancies with known mortality in familial adenomatous polyposis (FAP) patients. Visualization of the major duodenal papilla (MDP) with a standard esophagogastroduodenoscopy (EGD) is currently insufficient because of the limited field of view. Full-spectrum endoscopy (FUSE), utilizing double imagers located on the front and side of the endoscopic tip, provides a wider field of view up to 245 degrees. The aim of this study was to evaluate the efficacy of FUSE in visualizing MDP in patients with FAP.
This study was a single-center retrospective study including 49 FAP patients undergoing surveillance at our institution. EGD was performed by qualified endoscopists using FUSE, and visibility of the MDP was evaluated. All examinations were video-recorded, and the clips for individual patient were edited to forward view images alone (conventional group) and 2-view images of the duodenum (forward and side-view [FUSE group]). Three other qualified external endoscopists independently reviewed the videos and compared the visibility of MDP between the conventional and the FUSE groups. Primary endpoint was the rate of Type 1 visibility (whole area of the papilla) in off-site video reviews. We also assessed MDP visibility on-site as secondary endpoint.
The rate of type 1 MDP visibility was significantly higher in the FUSE group than conventional group in both on-site (32.6/100%, p < 0.001) and off-site reviews (8.2, 16.3, 14.3/100, 98, and 100%, p < 0.001).
FUSE is recommended in screening and surveillance EGD to better visualize MDP in FAP patients.
十二指肠癌是家族性腺瘤性息肉病（FAP）患者已知的致死性结外恶性肿瘤之一。由于视野有限，标准的食管胃十二指肠镜（EGD）目前无法充分观察主要十二指肠乳头（MDP）。全谱内镜（FUSE）利用位于内镜尖端前后两侧的两个成像器，提供更宽的视野，可达 245 度。本研究旨在评估 FUSE 观察 FAP 患者 MDP 的效果。
这是一项单中心回顾性研究，包括在我院接受监测的 49 例 FAP 患者。由合格的内镜医生使用 FUSE 进行 EGD，并评估 MDP 的可视性。所有检查均进行视频记录，并对每位患者的检查剪辑进行编辑，仅保留正向前视图图像（常规组）和十二指肠的 2 视图图像（正向前视图和侧视图[FUSE 组]）。另外 3 名合格的外部内镜医生独立观看视频，并比较常规组和 FUSE 组 MDP 的可视性。主要终点是场外视频回顾中 MDP 可视率 1 型（乳头的整个区域）。我们还将 MDP 的可视性作为次要终点进行现场评估。
FUSE 组 MDP 可视率在现场（32.6/100%，p < 0.001）和场外（8.2、16.3、14.3/100、98 和 100%，p < 0.001）回顾中均显著高于常规组。
建议在 FAP 患者的筛查和监测 EGD 中使用 FUSE，以更好地观察 MDP。
