对于溃疡性结肠炎患者发育异常的长期随访检测，靶向活检的色素内镜检查优于白光内镜检查：一项多中心随机对照试验。
Chromoendoscopy with targeted biopsies is superior to white-light endoscopy for the long-term follow-up detection of dysplasia in ulcerative colitis patients: a multicenter randomized-controlled trial.
作者信息
Wan Jian, Zhang Qin, Liang Shu-Hui, Zhong Jie, Li Jing-Nan, Ran Zhi-Hua, Zhi Fa-Chao, Wang Xiao-Di, Zhang Xiao-Lan, Wen Zhong-Hui, Sheng Jian-Qiu, Shi Hua-Xiu, Mei Qiao, Wu Kai-Chun
机构信息
State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, P. R. China.
Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China.
出版信息
Gastroenterol Rep (Oxf). 2020 Sep 20;9(1):14-21. doi: 10.1093/gastro/goaa028. eCollection 2021 Jan.
BACKGROUND
Data from single-center experience or small sample-sized studies have shown that chromoendoscopy (CE) might be superior to white-light endoscopy (WLE) for dysplasia surveillance in ulcerative colitis (UC) patients. We performed a prospective randomized trial with a long-term follow-up to compare the detection rate of dysplasia among WLE with targeted biopsies (WLT), WLE with random biopsies (WLR), and dye-based CE with targeted biopsies (CET) in UC patients.
METHODS
Patients with long-standing UC were enrolled from 11 medical centers from March 2012 to December 2013 and randomized into three arms (WLT, WLR, and CET). Only high-definition endoscopy was used in all three groups. The patients were followed up by annual endoscopy with biopsies through December 2017.
RESULTS
With a median follow-up time of 55 months, a total of 122 patients with 447 colonoscopies were finally analysed in the per-protocol set: WLT ( = 43), WLR ( = 40), and CET ( = 39). A total of 34 dysplastic lesions were found in 29 colonoscopies of 21 patients. WLR and CET could identify more colonoscopies that diagnosed dysplasia than WLT (8.1% and 9.7% vs 1.9%; = 0.014 and 0.004, respectively). WLR obtained more biopsied samples than WLT and CET (16.4 ± 5.1 vs 4.3 ± 1.4 and 4.3 ± 1.4; both < 0.001). During the second half of the follow-up (37 - 69 months), CET could identify more colonoscopies that diagnosed dysplasia than WLT (13.3% vs 1.6%, = 0.015) and showed a trend for increasing the detection rate compared with WLR (13.3% vs 4.9%, = 0.107).
CONCLUSIONS
For a better outcome of cancer/dysplasia surveillance in patients with long-standing UC, CET appeared to be more effective than WLT and less tedious than WLR. CET was found to be particularly useful when a long-term (>3 years) follow-up was conducted for dysplasia surveillance. The trial was registered on www.chictr.org.cn (ChiCTR1900023689).
背景
来自单中心经验或小样本量研究的数据表明，在溃疡性结肠炎（UC）患者的发育异常监测中，染色内镜检查（CE）可能优于白光内镜检查（WLE）。我们进行了一项长期随访的前瞻性随机试验，以比较WLE靶向活检（WLT）、WLE随机活检（WLR）和基于染料的CE靶向活检（CET）在UC患者中发育异常的检出率。
方法
2012年3月至2013年12月，从11个医疗中心招募了患有长期UC的患者，并随机分为三组（WLT、WLR和CET）。所有三组均仅使用高清内镜。对患者进行年度内镜检查并活检，随访至2017年12月。
结果
中位随访时间为55个月，最终在符合方案集中分析了122例患者的447次结肠镜检查：WLT组（n = 43）、WLR组（n = 40）和CET组（n = 39）。在21例患者的29次结肠镜检查中总共发现了34个发育异常病变。WLR和CET能够识别出比WLT更多的诊断为发育异常的结肠镜检查（分别为8.1%和9.7%对1.9%；P分别为0.014和0.004）。WLR获得的活检样本比WLT和CET更多（16.4±5.1对4.3±1.4和4.3±1.4；P均<0.001）。在随访的后半期（37 - 69个月），CET能够识别出比WLT更多的诊断为发育异常的结肠镜检查（13.3%对1.6%，P = 0.015），并且与WLR相比显示出提高检出率的趋势（13.3%对4.9%，P = 0.107）。
结论
为了在长期UC患者中获得更好的癌症/发育异常监测结果，CET似乎比WLT更有效，并且比WLR更不繁琐。当对发育异常监测进行长期（>3年）随访时，发现CET特别有用。该试验已在www.chictr.org.cn上注册（ChiCTR1900023689）。
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