Department of Anesthesiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, Hangzhou, China.
Department of Anesthesiology, the Children's Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
BMC Anesthesiol. 2021 Mar 30;21(1):97. doi: 10.1186/s12871-021-01312-x.
Confocal laser endomicroscopy (CLE) has advantages in detecting gastric neoplastic lesions, meanwhile it requires strict patient cooperation. Sedation could improve patient cooperation and quality of endoscopy. However, sedation is still not very popular in some resource-limited countries and regions. The purpose of this study was to compare propofol-based sedated versus un-sedated CLE in the value of diagnosing early gastric cancer (EGC) and precancerous lesions.
A retrospective, cohort, single center study of 226 patients who underwent CLE between January 1, 2015 and December 31, 2017 was performed. Patients enrolled were allocated into the propofol-based sedated group (n = 126) and the un-sedated group (n = 100). The comparison of validity and reliability of CLE for identifying EGC and precancerous lesions between the two groups was performed through analyzing CLE diagnosis and pathological diagnosis. Reporting followed the STROBE guidelines.
The area under receiver operating characteristic curve (AUROC) of diagnosing EGC in the sedated group was 0.97 (95 % CI: 0.95 to 0.99), which was higher than that in the un-sedated group (0.88 (95 % CI: 0.80 to 0.97), P = 0.0407). CLE with sedation performed better than without sedation in diagnosing intraepithelial neoplasia and intestinal metaplasia (P = 0.0008 and P = 0.0001, respectively). For patients considered as high-grade intraepithelial neoplasia or EGC by endoscopists, they would not get biopsy during CLE but receive endoscopic submucosal dissection (ESD) subsequently, and the misdiagnosis rate of CLE was 0 % in the sedated group and 27.59 % (95 % CI: 10.30-44.91 %) in the un-sedated group (P = 0.006).
Propofol based sedation was associated with improved diagnostic value of CLE for detecting EGC as well as precancerous lesions (intraepithelial neoplasia OR intestinal metaplasia).
共聚焦激光内镜检查（CLE）在检测胃肿瘤性病变方面具有优势，同时它需要患者的密切配合。镇静可以改善患者的配合度和内镜质量。然而，在一些资源有限的国家和地区，镇静仍未得到广泛应用。本研究旨在比较基于异丙酚的镇静与非镇静 CLE 在诊断早期胃癌（EGC）和癌前病变方面的价值。
回顾性、队列、单中心研究纳入 2015 年 1 月 1 日至 2017 年 12 月 31 日期间接受 CLE 的 226 例患者。患者被分为基于异丙酚的镇静组（n=126）和非镇静组（n=100）。通过分析 CLE 诊断和病理诊断，比较两组 CLE 识别 EGC 和癌前病变的有效性和可靠性。报告遵循 STROBE 指南。
镇静组诊断 EGC 的受试者工作特征曲线下面积（AUROC）为 0.97（95%CI：0.95 至 0.99），高于非镇静组的 0.88（95%CI：0.80 至 0.97），P=0.0407。CLE 镇静组在诊断上皮内瘤变和肠上皮化生方面优于非镇静组（P=0.0008 和 P=0.0001）。对于内镜医生认为是高级上皮内瘤变或 EGC 的患者，他们在 CLE 期间不会进行活检，而是随后接受内镜黏膜下剥离术（ESD），镇静组的 CLE 误诊率为 0%，而非镇静组为 27.59%（95%CI：10.30%至 44.91%），P=0.006。
基于异丙酚的镇静与 CLE 检测 EGC 及癌前病变（上皮内瘤变或肠上皮化生）的诊断价值提高有关。
