Pamudurthy Vijeta, Lodhia Nayna, Konda Vani J A
Department of Medicine, Riverside Medical CenterKankakeeIllinois.
Department of Medicine, University of Chicago Medical CenterChicagoIllinois.
Proc (Bayl Univ Med Cent). 2019 Dec 18;33(1):28-35. doi: 10.1080/08998280.2019.1686327. eCollection 2020 Jan.
While colonoscopy is considered the gold standard for colon cancer screening, recent advancements in endoscopes have allowed for improved visualization of the colonic mucosa and improved polyp detection rates. Newer technologies also allow for assessment of structural changes for polyp discrimination and determination of histologic type. Classification of polyps prevents the need for a histopathologic report, which requires the additional time and expertise of a pathologist and adds to the overall cost. This review considered advances in endoscopic technologies reported in PubMed over the past 12 years. Technologies that allow for increased visual field of colonic mucosa and may lead to improved colon polyp detection rates include cap-assisted colonoscopy, RetroView, extra-wide-angle view colonoscope, full-spectrum endoscopy, Third Eye Retroscope, NaviAid G-EYE balloon colonoscope, EndoRings, and Endocuff. Image-enhancing methods allow for pit pattern analysis of colorectal lesions, which enables the physician to classify colorectal polyps according to certain polyp characteristics. Image-enhancing methods include chromoendoscopy, autofluorescence, and virtual chromoendoscopy, including narrow band imaging, i-SCAN, flexible spectral imaging chromoendoscopy, and STORZ professional image enhancement systems. In addition, advancements have been made in in vivo microscopic evaluation of colonic epithelium, including confocal laser endomicroscopy, endocytoscopy, optical coherence tomography, spectroscopy, and autofluorescence spectroscopy. Colon capsule endoscopy also has a role in colon polyp detection and classification. The advancements in polyp detection and classification have great promise for earlier detection and removal of advanced adenomas before they advance to colorectal cancer.
虽然结肠镜检查被认为是结肠癌筛查的金标准，但内窥镜的最新进展已使结肠黏膜的可视化得到改善，息肉检测率也有所提高。新技术还能够评估结构变化以鉴别息肉并确定组织学类型。息肉分类避免了对组织病理学报告的需求，组织病理学报告需要病理学家额外的时间和专业知识，并且会增加总体成本。本综述考虑了过去12年在PubMed上报道的内窥镜技术进展。能够增加结肠黏膜视野并可能提高结肠息肉检测率的技术包括帽辅助结肠镜检查、RetroView、超广角视野结肠镜、全光谱内窥镜检查、第三眼逆行内窥镜、NaviAid G-EYE球囊结肠镜、EndoRings和Endocuff。图像增强方法可对结直肠病变进行凹陷模式分析，这使医生能够根据某些息肉特征对结直肠息肉进行分类。图像增强方法包括色素内镜检查、自体荧光和虚拟色素内镜检查，包括窄带成像、i-SCAN、灵活光谱成像色素内镜检查和STORZ专业图像增强系统。此外，在结肠上皮的体内显微镜评估方面也取得了进展，包括共聚焦激光显微内镜检查、内镜细胞检查、光学相干断层扫描、光谱学和自体荧光光谱学。结肠胶囊内镜检查在结肠息肉检测和分类中也发挥着作用。息肉检测和分类方面的进展对于在晚期腺瘤发展为结直肠癌之前更早地检测和切除具有很大的前景。
