Te Groen Maarten, Wijnands Anouk M, den Broeder Nathan, de Jong Dirk J, van Dop Willemijn A, Duijvestein Marjolijn, Fidder Herma H, van Schaik Fiona, Hirdes Meike M C, van der Meulen-de Jong Andrea E, Maljaars P W Jeroen, Voorneveld Philip W, de Boer K H Nanne, Peters Charlotte P, Oldenburg Bas, Hoentjen Frank
Inflammatory Bowel Disease Centre, Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands.
Inflammatory Bowel Disease Centre, Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands.
Gut. 2025 Mar 6;74(4):547-556. doi: 10.1136/gutjnl-2024-333446.
It remains unclear if the increased colorectal neoplasia detection rate in inflammatory bowel disease (IBD) by high-definition (HD) dye-based chromoendoscopy compared with HD white-light endoscopy is due to enhanced contrast or increased inspection times. Longer withdrawal times may yield similar neoplasia detection rates as found by HD chromoendoscopy.
To compare colorectal neoplasia detection rates for HD white-light endoscopy with segmental re-inspection and HD chromoendoscopy, using single-pass HD white-light endoscopy as an additional control group.
In a multicentre, randomised controlled trial, IBD patients aged ≥18 years without active disease and scheduled for endoscopic surveillance were included. Patients were 2:2:1 randomised to HD white-light endoscopy with segmental re-inspection of each colonic segment (double pass), HD chromoendoscopy or single-pass HD white-light endoscopy. The primary outcome was colorectal neoplasia detection rate. Assuming equal colorectal neoplasia rates (non-inferiority margin of 10%) between segmental re-inspection and chromoendoscopy and superiority of segmental re-inspection vs single-pass HD white-light endoscopy, a sample size of 566 patients was required.
In total, 563 patients were analysed per-protocol. Colorectal neoplasia detection rates were 10.3% (n=24/234) for HD white-light endoscopy with segmental re-inspection and 13.1% (n=28/214) for HD chromoendoscopy. This confirmed non-inferiority to HD chromoendoscopy (Δ-2.8%, lower limit 95% CI -7.8, p<0.01). In addition, the number of detected colorectal neoplasia per 10 min of withdrawal time was similar between HD white-light endoscopy with segmental re-inspection and HD chromoendoscopy (0.062 vs 0.058, p=0.83). Single-pass HD white-light endoscopy yielded a lower colorectal neoplasia rate (6.1%; n=7/115) than segmental re-inspection but this was not statistically significant (Δ4.1%, 95% CI -2.2:9.6%, p=0.19).
HD white-light endoscopy with segmental re-inspection was non-inferior to HD chromoendoscopy for colorectal neoplasia detection in IBD patients. It can therefore be assumed that the benefit of HD chromoendoscopy may be explained by the longer withdrawal time and not necessarily the enhanced contrast. However, re-inspection per se did not lead to a significantly higher colorectal neoplasia rate than single-pass HD white-light endoscopy alone.
与高清白光内镜检查相比，基于染料的高清色素内镜检查在炎症性肠病（IBD）中提高了结直肠癌的检出率，其原因尚不清楚，是由于对比度增强还是检查时间增加。更长的退镜时间可能会产生与高清色素内镜检查相似的肿瘤检出率。
将高清白光内镜分段复查与高清色素内镜检查的结直肠癌检出率进行比较，并将单通道高清白光内镜检查作为额外的对照组。
在一项多中心随机对照试验中，纳入年龄≥18岁、无活动性疾病且计划接受内镜监测的IBD患者。患者按2:2:1随机分为接受各结肠段分段复查的高清白光内镜检查（双通道）、高清色素内镜检查或单通道高清白光内镜检查。主要结局是结直肠癌检出率。假设分段复查与色素内镜检查的结直肠癌发生率相等（非劣效性界值为10%），且分段复查优于单通道高清白光内镜检查，则需要566例患者的样本量。
根据方案共分析了563例患者。接受分段复查的高清白光内镜检查的结直肠癌检出率为10.3%（n = 24/234），高清色素内镜检查的检出率为13.1%（n = 28/214）。这证实了其不劣于高清色素内镜检查（差值-2.8%，95%置信区间下限-7.8，p<0.01）。此外，接受分段复查的高清白光内镜检查与高清色素内镜检查每10分钟退镜时间内检测到的结直肠癌数量相似（分别为0.062和0.058，p = 0.83）。单通道高清白光内镜检查的结直肠癌发生率（6.1%；n = 7/115）低于分段复查，但差异无统计学意义（差值4.1%，95%置信区间-2.2:9.6%，p = 0.19）。
在IBD患者中，接受分段复查的高清白光内镜检查在结直肠癌检测方面不劣于高清色素内镜检查。因此，可以认为高清色素内镜检查的益处可能是由于退镜时间更长，而不一定是对比度增强。然而，单纯的复查本身并未导致结直肠癌发生率显著高于单通道高清白光内镜检查。
