Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
Department of Gastroenterology, Niiza Shiki Central General Hospital, Saitama, Japan.
J Hepatobiliary Pancreat Sci. 2021 May;28(5):431-442. doi: 10.1002/jhbp.894. Epub 2021 Mar 5.
Red dichromatic imaging (RDI) is next-generation image-enhanced endoscopy technique released in July 2020. We previously reported that RDI can predict esophageal varices (EV) depth and decrease their recurrence rate by accurate intravariceal injections during endoscopic injection sclerotherapy (EIS) using unreleased prototype RDI endoscope. In this study, we analyzed whether RDI improves the overall survival (OS) rate and whether it is more accurate independent predictor of EV recurrence than white light imaging (WLI), using propensity score matching.
A total of 179 patients were enrolled. Patients were matched for age, platelet count, liver function, EV size, luminal diameter, and EV depth using propensity score matching, and 78 patients (RDI, 39; WLI, 39) were finally matched. Primary endpoints were OS and recurrence rates. Secondary endpoints were success rate of intravariceal injection, operating time, incidence of adverse events (AEs), and predictors associated with OS and recurrence rates.
There was no difference in OS (P = .193), but the cumulative recurrence rate in the RDI group was significantly lower than in the WLI group (P = .002). Success rates of intrainjection, operating time, and incidence of AEs were better in the RDI group (p = 0.035, .026, and .0019, respectively). Independent predictors associated with recurrence rate by Cox proportional regression were RDI function and luminal diameter (P < .001 and .017, respectively).
RDI did not improve OS but decreased the recurrence rate. Independent predictors of recurrence rate were RDI and luminal diameter, resulting from secure intravariceal injections in EIS.
红双对比成像（RDI）是 2020 年 7 月推出的下一代图像增强内镜技术。我们之前报道过，使用未发布的原型 RDI 内镜进行内镜下注射硬化治疗（EIS）时，RDI 可以通过准确的腔内注射预测食管静脉曲张（EV）的深度，并降低其复发率。在这项研究中，我们通过倾向评分匹配分析 RDI 是否提高了总体生存率（OS），以及它是否比白光成像（WLI）更准确地独立预测 EV 复发。
共纳入 179 例患者。采用倾向评分匹配，根据年龄、血小板计数、肝功能、EV 大小、管腔直径和 EV 深度匹配患者，最终匹配 78 例患者（RDI 组 39 例，WLI 组 39 例）。主要终点是 OS 和复发率。次要终点是腔内注射成功率、手术时间、不良事件（AE）发生率，以及与 OS 和复发率相关的预测因素。
两组患者的 OS 无差异（P=0.193），但 RDI 组的累积复发率明显低于 WLI 组（P=0.002）。RDI 组的腔内注射成功率、手术时间和 AE 发生率均优于 WLI 组（P=0.035、0.026 和 0.0019）。Cox 比例风险回归分析显示，与复发率相关的独立预测因素为 RDI 功能和管腔直径（P<0.001 和 0.017）。
RDI 并未改善 OS，但降低了复发率。复发率的独立预测因素是 RDI 和管腔直径，这得益于 EIS 中安全的腔内注射。
