Gastroenterology and Endoscopy Division, European Georges Pompidou Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.
Paris-Descartes University, Sorbonne Paris Cité, Paris, France.
Am J Gastroenterol. 2019 Oct;114(10):1665-1670. doi: 10.14309/ajg.0000000000000386.
Colonoscopic screening with indigo carmine chromoendoscopy (ICC) in patients with Lynch syndrome (LS) improves the adenoma detection rate but is time consuming and poorly used in clinical practice. Narrow-band imaging (NBI), a virtual chromoendoscopy technique, highlights superficial mucosal vessels and improves adenoma characterization. We conducted a prospective multicenter trial in a back-to-back fashion to compare the third-generation NBI with ICC for detecting colonic adenomas in patients with LS.
In a multicenter, prospective, noninferiority trial, 138 patients underwent a double colonoscopy, first with NBI, followed by ICC, in a back-to-back design. The primary noninferiority outcome measure was the number of patients with at least one adenoma after NBI compared with the number of patients with at least one adenoma after NBI and ICC.
The 138 analyzable patients were all proven mismatch repair mutation carriers for LS (MLH1 = 33%, MSH2 = 47%, MSH6 = 15%, PMS2 = 4%, and EPCAM = 1%). The mean age (SD) was 40.5 (14.7) years, and 64 (46.4%) were men. The median withdrawal time for an NBI procedure was 8 minutes (interquartile range 6-11) compared with 13 minutes (interquartile range 8-17) for ICC. At least one adenoma was detected during the initial NBI pass in 28 patients (20.3%), and 42 patients (30.4%) had at least one adenoma detected after both NBI and ICC (difference, 10.1%; 95% confidence interval, -0.1%-20.3%); this represents an increase of 50.0% of the adenoma detection rate. ICC detected additional adenomas in 25 patients (18.1%).
Colonoscopy combining NBI and ICC detects more adenomas than third-generation NBI alone in patients with LS, respectively, 30.4% vs 20.3% (difference, 10.1%; 95% confidence interval, -0.1 to 20.3), thus failing the noninferiority assumption of NBI compared with combined NBI and ICC. Although less time consuming, colonoscopy using the third-generation NBI cannot be recommended to replace ICC in patients with LS.
在林奇综合征（LS）患者中进行靛胭脂染色的结肠镜筛查（ICC）可提高腺瘤检出率，但耗时且在临床实践中应用不佳。窄带成像（NBI）是一种虚拟染色内镜技术，可突出显示黏膜表面的小血管，从而改善腺瘤的特征。我们以背靠背的方式进行了一项前瞻性多中心试验，比较了第三代 NBI 与 ICC 在 LS 患者中检测结肠腺瘤的效果。
在一项多中心前瞻性非劣效性试验中，138 例患者进行了两次结肠镜检查，首先进行 NBI 检查，然后进行 ICC 检查，采用背靠背设计。主要非劣效性结局指标为 NBI 检查后至少有 1 例腺瘤的患者数量与 NBI 和 ICC 检查后至少有 1 例腺瘤的患者数量之比。
138 例可分析患者均为 LS 错配修复基因突变携带者（MLH1 = 33%，MSH2 = 47%，MSH6 = 15%，PMS2 = 4%，EPCAM = 1%）。平均年龄（SD）为 40.5（14.7）岁，64 例（46.4%）为男性。NBI 操作的中位退镜时间为 8 分钟（四分位距 6-11），而 ICC 为 13 分钟（四分位距 8-17）。28 例（20.3%）在初次 NBI 检查时发现至少 1 个腺瘤，42 例（30.4%）在 NBI 和 ICC 检查后均发现至少 1 个腺瘤（差异 10.1%；95%置信区间 -0.1%至 20.3%）；这表示腺瘤检出率增加了 50.0%。ICC 在 25 例（18.1%）患者中检出了额外的腺瘤。
在 LS 患者中，与单独使用第三代 NBI 相比，NBI 联合 ICC 检测到的腺瘤更多，分别为 30.4%和 20.3%（差异 10.1%；95%置信区间 -0.1%至 20.3%），因此第三代 NBI 与 NBI 和 ICC 联合应用相比不具有非劣效性。尽管 NBI 检查耗时较少，但不建议将其用于 LS 患者的 ICC 替代。
