Computer-aided detection, mucosal exposure device, their combination, and standard colonoscopy for adenoma detection: a randomized controlled trial
Computer-aided detection, mucosal exposure device, their combination, and standard colonoscopy for adenoma detection: a randomized controlled trial
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DOI：
10.1016/j.gie.2022.09.023
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发表时间：
2023-02-17
影响因子：
7.7
通讯作者：
Rerknimitr, Rungsun
中科院分区：
文献类型：
--
作者：
Aniwan, Satimai;Mekritthikrai, Krittaya;Rerknimitr, Rungsun
背景和目的：计算机辅助检测（CADe）和粘膜暴露装置可以提高腺瘤检出率（ADR）。从未研究过结合这两种方式的潜在好处。本研究旨在比较单独使用 CADe、单独使用内袋辅助结肠镜检查 (EAC) 以及使用标准结肠镜检查联合使用 CADe 和 EAC (CADe+EAC) 之间的 ADR 差异。 方法：这项前瞻性随机对照研究纳入了 1245 名接受结肠镜筛查的参与者。参与者被随机分配到 CADe、EAC、CADe+EAC 组和标准结肠镜检查组作为对照。主要结局是 ADR。次要结局是近端 ADR (pADR)、晚期 ADR (AADR) 和每次结肠镜检查的腺瘤数量 (APC)。 结果：对照组、CADe、EAC 和 CADe+EAC 组的 ADR 分别为 41.9%、52.2%、54.0% 和 58.8%； pADR 分别为 25.2%、33.3%、34.9% 和 37.0%； AADR 分别为 7.7%、8.3%、8.3% 和 13.6%；和 APC 分别为 0.76、1.11、1.18 和 1.31。干预组和对照组之间的 ADR 和 pADR 显着增加（所有比较中 P < .05）。仅 CADe+EAC 组的 AADR 显着高于对照组 (P = .02)。调整后的 APC 发生率在干预组中显着高于对照组（所有比较中 P < .01）。 结论：与标准结肠镜检查相比，CADe+EAC 显着改善了 ADR 和 AADR。然而，尽管单独使用 CADe 或 EAC 可以显着增加腺瘤的检出率，但除非联合使用，否则它们不会导致晚期腺瘤的检出率增加。
Background and Aims: Computer-aided detection (CADe) and a mucosal exposure device can improve ade-noma detection rate (ADR). Potential benefits of combining the 2 modalities have never been studied. This study aimed to compare ADR differences among CADe alone, endocuff-assisted colonoscopy (EAC) alone, and the com-bination of CADe and EAC (CADe+EAC) with standard colonoscopy.Methods: This prospective randomized controlled study included 1245 participants who underwent screening colonoscopy. Participants were randomized to CADe, EAC, CADe+EAC, and standard colonoscopy as a control. The primary outcome was ADR. Secondary outcomes were proximal ADR (pADR), advanced ADR (AADR), and the number of adenomas per colonoscopy (APCs).Results: ADRs from the control, CADe, EAC, and CADe+EAC groups were 41.9%, 52.2%, 54.0%, and 58.8%, respectively; pADRs were 25.2%, 33.3%, 34.9%, and 37.0%, respectively; AADRs were 7.7%, 8.3%, 8.3%, and 13.6%, respectively; and APCs were .76, 1.11, 1.18, and 1.31, respectively. Significant increases in ADR and pADR were observed between the inter-vention and control groups (P < .05 in all comparisons). The AADR was significantly higher only in the CADe+EAC group than in the control group (P = .02). The adjusted incidence rate ratios of APCs were significantly higher in the intervention groups versus the control group (P < .01 in all comparisons).Conclusions: CADe+EAC significantly improve ADR and AADR over standard colonoscopy. However, although CADe or EAC alone can substantially increase the detection of adenomas, they do not lead to increased detection of advanced adenomas unless used in combination.