Department of Medicine Solna, Karolinska Institutet, Division of endoscopy, Karolinska University Hospital, Stockholm, Sweden.
Department of Medicine Solna, Karolinska Institutet, Division of endoscopy, Karolinska University Hospital, Stockholm, Sweden; Stress Research Institute, Stockholm University, Stockholm, Sweden; Department of Psychology, Macquarie University, Sydney, New South Wales, Australia.
Clin Gastroenterol Hepatol. 2020 Aug;18(9):2101-2107. doi: 10.1016/j.cgh.2020.04.049. Epub 2020 Apr 27.
BACKGROUND & AIMS: There is debate over the optimal method for colonoscopic surveillance of patients with inflammatory bowel diseases. Guidelines recommend chromoendoscopy, but the value of chromoendoscopy in high-definition colonoscopy has not been proven. Furthermore, the value of random biopsies is controversial.
We performed a prospective study of 305 patients with ulcerative colitis or Crohn's colitis referred for surveillance colonoscopy at a university hospital in Sweden, from March 2011 through April 2016. Patients randomly assigned to a group that received high-definition chromoendoscopy with indigo carmine (HD-CE; n = 152), collection of 32 random biopsies, and targeted biopsies or polypectomies or to a group that received high-definition white light endoscopy (HD-WLE; n = 153), collection of 32 random biopsies, and targeted biopsies or polypectomies. The primary endpoint was number of patients with dysplastic lesions.
Dysplastic lesions were detected in 17 patients with HD-CE and 7 patients with HD-WLE (P = .032). Dysplasias in random biopsies (n = 9760) were detected in 9 patients: 6 (3.9%) in the HD-CE group and 3 (2.0%) in the HD-WLE group (P = .72). Of the 9 patients with dysplasia, 3 patients (33%) had primary sclerosing cholangitis-only 18% of patients (54/305) included in the study had primary sclerosing cholangitis. The number of dysplastic lesions per 10 min of withdrawal time was 0.066 with HD-CE and 0.027 with HD-WLE (P = .056).
In a randomized trial, we found HD-CE with collection of random biopsies to be superior to HD-WLE with random biopsies for detection of dysplasia per colonoscopy. These results support the use of chromoendoscopy for surveillance of patients with inflammatory bowel diseases. ClinicalTrials.gov no: NCT01505842.
对于炎症性肠病患者的结肠镜监测，哪种方法最优尚存争议。指南推荐使用染色内镜，但高清结肠镜下染色的价值尚未得到证实。此外，随机活检的价值也存在争议。
我们对 2011 年 3 月至 2016 年 4 月在瑞典一家大学医院因结肠镜监测而就诊的溃疡性结肠炎或克罗恩病患者进行了一项前瞻性研究。患者被随机分配至接受高清染色内镜（HD-CE）联合靛胭脂染色（n=152）、采集 32 份随机活检标本、并进行靶向活检或息肉切除术，或接受高清白光内镜（HD-WLE）联合随机活检标本采集（n=153）、进行靶向活检或息肉切除术。主要终点为发现异型增生性病变的患者数量。
HD-CE 组中 17 例患者和 HD-WLE 组中 7 例患者发现异型增生性病变（P=0.032）。在 9760 份随机活检标本中发现 9 例异型增生：HD-CE 组 6 例（3.9%），HD-WLE 组 3 例（2.0%）（P=0.72）。在 9 例异型增生患者中，有 3 例（33%）患有原发性硬化性胆管炎——仅研究中的 18%（54/305）患者患有原发性硬化性胆管炎。HD-CE 组和 HD-WLE 组每 10 min 退镜时间发现异型增生性病变的数量分别为 0.066 个和 0.027 个（P=0.056）。
在一项随机试验中，我们发现与 HD-WLE 联合随机活检相比，HD-CE 联合随机活检在每次结肠镜检查时发现异型增生的效果更优。这些结果支持使用染色内镜对炎症性肠病患者进行监测。临床试验注册编号：NCT01505842。
