Standard endoscopy with random biopsies versus narrow band imaging targeted biopsies in Barrett's oesophagus: a prospective, international, randomised controlled trial
Standard endoscopy with random biopsies versus narrow band imaging targeted biopsies in Barrett's oesophagus: a prospective, international, randomised controlled trial
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DOI：
10.1136/gutjnl-2011-300962
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发表时间：
2013-01-01
期刊：
影响因子：
24.5
通讯作者：
Bergman, Jacques J.
中科院分区：
文献类型：
--
作者：
Sharma, Prateek;Hawes, Robert H.;Bergman, Jacques J.
背景白光内镜随机活检是检测Barrett食管（BO）患者肠化生（IM）和瘤变的标准方法。窄带成像（NBI）突出了BO中与IM和肿瘤相关的表面模式。目的比较高清晰度白光（HD-WLE）和NBI在BO中IM和肿瘤的检测效果。Design International，比较HD-WLE和NBI的随机交叉试验。在三个三级转诊中心进行BO筛查/监测的患者被前瞻性纳入，并随机分配到HD-WLE或NBI，随后在3-8周内进行其他程序。在HD-WLE期间，每2 cm进行4个象限活检，并对可见病变进行靶向活检（西雅图方案）。在NBI检查期间，粘膜和血管模式被注意到，并进行了靶向活检。所有的活组织检查都由一名胃肠病理学专家以盲法阅读。结果共纳入123例BO患者，平均年龄61岁，男性93%，白人97%，平均周长和最大长度分别为1.8 cm和3.6 cm。HD-WLE和NBI均检测出104/113例（92%）IM患者，但NBI每位患者需要较少的活检(3.6 vs 7.6, p
Background White light endoscopy with random biopsies is the standard for detection of intestinal metaplasia (IM) and neoplasia in patients with Barrett's oesophagus (BO). Narrow band imaging (NBI) highlights surface patterns that correlate with IM and neoplasia in BO.Objective To compare high-definition white light (HD-WLE) and NBI for detection of IM and neoplasia in BO.Design International, randomised, crossover trial comparing HD-WLE and NBI. Patients referred for BO screening/surveillance at three tertiary referral centres were prospectively enrolled and randomised to HD-WLE or NBI followed by other procedures in 3-8 weeks. During HD-WLE, four quadrant biopsies every 2 cm, together with targeted biopsies of visible lesions (Seattle protocol), were obtained. During NBI examination, mucosal and vascular patterns were noted and targeted biopsies were obtained. All biopsies were read by a single expert gastrointestinal pathologist in a blinded fashion.Results 123 patients with BO (mean age 61; 93% male; 97% Caucasian) with mean circumferential and maximal extents of 1.8 and 3.6 cm, respectively, were enrolled. Both HD-WLE and NBI detected 104/113 (92%) patients with IM, but NBI required fewer biopsies per patient (3.6 vs 7.6, p