使用色素内镜检查和白光结肠镜检查对炎症性肠病患者进行监测以检测高级别瘤变。
Advanced neoplasia detection using chromoendoscopy and white light colonoscopy for surveillance in patients with inflammatory bowel disease.
作者信息
Kim Kyeong Ok, Chiorean Michael V
机构信息
Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea.
出版信息
Intest Res. 2020 Oct;18(4):438-446. doi: 10.5217/ir.2019.00090. Epub 2020 Oct 26.
BACKGROUND/AIMS: Chromoendoscopy (CE) has been shown to be superior to white light endoscopy (WLE) for neoplasia detection in inflammatory bowel disease (IBD). We aimed to compare the yield of CE and WLE for the detection of overall neoplasia and advanced neoplasia in IBD.
METHODS
Patients who underwent surveillance colonoscopy from 1999 to 2017 were identified from our IBD database. CE procedures were compared with their respective WLE controls in a paired comparison, and frequency of all neoplasia, advanced neoplasia, and serrated neoplasia was assessed for both targeted and random biopsies.
RESULTS
A total of 290 procedures performed in 98 individuals were identified with a median follow-up 4 years (median 3 colonoscopies/patient). CE and WLE were performed in 159 and 131 episodes, respectively. CE detected neoplasia in 40.9% of colonoscopies versus 23.7% with WLE (P= 0.002). In addition, CE detected more advanced neoplasia (18.2% vs. 6.1%, P= 0.002) and serrated lesions (14.5% vs. 6.1%, P= 0.022). Significantly fewer samples were obtained per procedure with CE (14.9 ± 9.7 vs. 20.9 ± 11.1, P< 0.001). Cancer was diagnosed in 2 cases.
CONCLUSIONS
CE has a higher detection rate than WLE for advanced neoplasia and serrated lesions in patients with IBD under surveillance. Further prospective studies evaluating the impact of CE on decreasing the risk of interval cancer and colectomy in IBD patients are warranted.
背景/目的：染色内镜检查（CE）已被证明在炎症性肠病（IBD）的肿瘤检测方面优于白光内镜检查（WLE）。我们旨在比较CE和WLE在IBD中检测总体肿瘤和进展期肿瘤的检出率。
方法
从我们的IBD数据库中识别出1999年至2017年接受监测结肠镜检查的患者。在配对比较中，将CE检查与各自的WLE对照进行比较，并评估靶向活检和随机活检中所有肿瘤、进展期肿瘤和锯齿状肿瘤的发生率。
结果
共识别出98例患者进行的290次检查，中位随访时间为4年（每位患者中位3次结肠镜检查）。分别进行了159次CE检查和131次WLE检查。CE在40.9%的结肠镜检查中检测到肿瘤，而WLE为23.7%（P = 0.002）。此外，CE检测到更多的进展期肿瘤（18.2%对6.1%，P = 0.002）和锯齿状病变（14.5%对6.1%，P = 0.022）。CE每次检查获取的样本明显更少（14.9±9.7对20.9±11.1，P<0.001）。诊断出2例癌症。
结论
在接受监测的IBD患者中，CE对进展期肿瘤和锯齿状病变的检测率高于WLE。有必要进行进一步的前瞻性研究，评估CE对降低IBD患者间期癌风险和结肠切除术风险的影响。
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