Pancolonic chromoendoscopy with indigo carmine versus standard colonoscopy for detection of neoplastic lesions: a randomised two-centre trial
Pancolonic chromoendoscopy with indigo carmine versus standard colonoscopy for detection of neoplastic lesions: a randomised two-centre trial
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DOI：
10.1136/gut.2010.229534
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发表时间：
2011-04-01
期刊：
影响因子：
24.5
通讯作者：
Ell, Christian
中科院分区：
文献类型：
--
作者：
Pohl, Juergen;Schneider, Arved;Ell, Christian
目的结肠镜检查是公认的检测结直肠腺瘤的金标准，但漏诊率，特别是小而扁平的病变，仍然高得令人无法接受。本研究的目的是确定是否使用泛结肠彩色内镜（PCC）增强粘膜造影剂可以提高腺瘤的检出率。方法在一项前瞻性、随机双中心试验中，对连续接受常规结肠镜检查的患者进行PCC（连续拔管期间喷喷0.4%靛蓝胭脂红）与标准结肠镜检查（对照组）的比较。病变的组织病理学检测是通过评估内镜切除或活检标本确认。结果共纳入1008例患者，其中PCC组496例，对照组512例。两组患者的人口学特征和结肠镜检查指征相似。PCC组至少有一个腺瘤的患者比例（46.2%）明显高于对照组（36.3%,p=0.002）。色内窥镜提高了腺瘤（0.95 vs 0.66 /例）、扁平腺瘤（0.56 vs 0.28 /例）和锯齿状病变（1.19 vs 0.49 /例）的总体检出率（p < 0.001）。晚期腺瘤检出率增加的趋势不显著（103比81；p=0.067）。PCC组平均拔管时间略长于对照组（11.6 +/- 3.36 min vs 10.1 +/- 2.03 min; p < 0.001）。结论泛结肠色内窥镜检查可显著提高平均风险人群的腺瘤检出率，值得常规应用。
Objective Colonoscopy is the accepted gold standard for detecting colorectal adenomas, but the miss rate, especially for small and flat lesions, remains unacceptably high. The aim of this study was to determine whether enhanced mucosal contrast using pancolonic chromoendoscopy (PCC) allows higher rates of adenoma detection.Methods In a prospective, randomised two-centre trial, PCC (with 0.4% indigo carmine spraying during continuous extubation) was compared with standard colonoscopy (control group) in consecutive patients attending for routine colonoscopy. The histopathology of the lesions detected was confirmed by evaluating the endoscopic resection or biopsy specimens.Results A total of 1008 patients were included (496 in the PCC group, 512 in the control group). The patients' demographic characteristics and indications for colonoscopy were similar in the two groups. The proportion of patients with at least one adenoma was significantly higher in the PCC group (46.2%) than in the control group (36.3%; p=0.002). Chromoendoscopy increased the overall detection rate for adenomas (0.95 vs 0.66 per patient), flat adenomas (0.56 vs 0.28 per patient) and serrated lesions (1.19 vs 0.49 per patient) (p < 0.001). There was a non-significant trend towards increased detection of advanced adenomas (103 vs 81; p=0.067). Mean extubation times were slightly but significantly longer in the PCC group in comparison with the control group (11.6 +/- 3.36 min vs 10.1 +/- 2.03 min; p < 0.001).Conclusions Pancolonic chromoendoscopy markedly enhances adenoma detection rates in an average-risk population and is practicable enough for routine application.