van Keulen K E, Soons E, Siersema P D
Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands.
Curr Treat Options Gastroenterol. 2019 Sep;17(3):394-407. doi: 10.1007/s11938-019-00242-5.
Colorectal cancer is one of the most common malignancies in the Western world and is thought to develop from premalignant polyps. Over the past decade, several behind folds visualizing techniques (BFTs) have become available to improve polyp detection. This systematic review and meta-analysis aims to compare BFTs with conventional colonoscopy (CC).
In the past five years, 14 randomized controlled trials (RCTs) including 8384 patients comparing different BFTs with CC were published. The overall relative risks for adenoma detection rate, polyp detection rate, and adenoma miss rate comparing BFTs with CC were 1.04 (95% confidence interval [CI] 0.98-1.10; P = 0.15), 1.03 (95% CI 0.98-1.09; P = 0.28), and 0.70 (95% CI 0.46-1.05; P = 0.08), respectively. Other quality metrics for colonoscopy were not significantly different between BFT-assisted colonoscopy and CC either. This meta-analysis of RCTs published in the past five years does not show a significant benefit of BFTs on any of the important quality metrics of colonoscopy. The lack of additional effect of BFTs might be due to improved awareness of colonoscopy quality metrics and colonoscopy skills among endoscopists combined with improvements of conventional colonoscope technology.
结直肠癌是西方世界最常见的恶性肿瘤之一，被认为是由癌前息肉发展而来。在过去十年中，出现了几种有助于观察皱襞的技术（BFTs）以提高息肉检测率。本系统评价和荟萃分析旨在比较BFTs与传统结肠镜检查（CC）。
在过去五年中，发表了14项随机对照试验（RCTs），包括8384例患者，比较了不同的BFTs与CC。将BFTs与CC相比，腺瘤检出率、息肉检出率和腺瘤漏诊率的总体相对风险分别为1.04（95%置信区间[CI]0.98-1.10；P=0.15）、1.03（95%CI 0.98-1.09；P=0.28）和0.70（95%CI 0.46-1.05；P=0.08）。BFT辅助结肠镜检查和CC在结肠镜检查的其他质量指标上也没有显著差异。对过去五年发表的RCTs进行的这项荟萃分析没有显示BFTs在结肠镜检查的任何重要质量指标上有显著益处。BFTs缺乏额外效果可能是由于内镜医师对结肠镜检查质量指标和结肠镜检查技能的认识提高，以及传统结肠镜技术的改进。
