Randomised controlled trial comparing modified Sano's and narrow band imaging international colorectal endoscopic classifications for colorectal lesions

AIM To assess the utility of modified Sano′s(MS) vs thenarrow band imaging international colorectal endoscopic(NICE) classification in differentiating colorectal polyps.METHODS Patients undergoing colonoscopy between 2013 and 2015 were enrolled in this trial.Based on the MS or the NICE classifications,patients were randomised for real-time endoscopic diagnosis.This was followed by biopsies,endoscopic or surgical resection.The endoscopic diagnosis was then compared to the final(blinded) histopathology.The primary endpoint was the sensitivity(Sn),specificity(Sp),positive predictive value(PPV) and negative predictive value(NPV) of differentiating neoplastic and non-neoplastic polyps(MSⅡ/Ⅱo/Ⅲa/Ⅲb vs I or NICE 1 vs 2/3).The secondary endpoints were "endoscopic resectability"(MSⅡ/Ⅱo/Ⅲa vs Ⅰ/Ⅲb or NICE 2 vs 1/3),NPV for diminutive distal adenomas and prediction of post-polypectomy surveillance intervals.RESULTS A total of 348 patients were evaluated.The Sn,Sp,PPV and NPV in differentiating neoplastic polyps from non-neoplastic polyps were,98.9%,85.7%,98.2% and 90.9% for MS;and 99.1%,57.7%,95.4% and 88.2% for NICE,respectively.The area under the receiver operating characteristic curve(AUC) for MS was 0.92(95%CI:0.86-0.98);and AUC for NICE was 0.78(95%CI:0.69,0.88).The Sn,Sp,PPV and NPV in predicting "endoscopic resectability" were 98.9%,86.1%,97.8% and 92.5% for MS;and 98.6%,66.7%,94.7% and 88.9% for NICE,respectively.The AUC for MS was 0.92(95%CI:0.87-0.98);and the AUC for NICE was 0.83(95%CI:0.75-0.90).The AUC values were statistically different for both comparisons(P = 0.0165 and P = 0.0420,respectively).The accuracy for diagnosis of sessile serrated adenoma/polyp(SSA/P) with high confidence utilizing MS classification was 93.2%.The differentiation of SSA/P from other lesions achieved Sp,Sn,PPV and NPV of 87.2%,91.5%,89.6% and 98.6%,respectively.The NPV for predicting adenomas in diminutive rectosigmoid polyps(n = 150) was 96.6% and 95% with MS and NICE respectively.The calculated accuracy of post-polypectomy surveillance for MS group was 98.2%(167 out of 170) and for NICE group was 92.1%(139 out of 151).CONCLUSION The MS classification outperformed the NICE classification in differentiating neoplastic polyps and predicting endoscopic resectability.Both classifications met ASGE PIVI thresholds.     

Polyp detection rates using magnification with narrow band imaging and white light

AIM: To compare the yield of adenomas between narrow band imaging and white light when using high definition/magnification. METHODS: This prospective, non-randomized comparative study was performed at the endoscopy unit of veteran affairs medical center in Phoenix, Arizona. Consecutive patients undergoing first average risk colorectal cancer screening colonoscopy were selected. Two experienced gastroenterologists performed all the procedures that were blinded to each other's findings. Demographic details were recorded. Data are presented as mean ± SEM. Proportional data were compared using the χ2 test and means were compared using the Student's t test. Tandem colonoscopy was performed in a sequential and segmental fashion using one of 3 strategies: white light followed by narrow band imaging [Group A: white light(WL) → narrow band imaging(NBI)]; narrow band imaging followed by white light(Group B: NBI → WL) and, white light followed by white light(Group C: WL → WL). Detection rate of missed polyps and adenomas were evaluated in all three groups. RESULTS: Three hundred patients were studied(100 in each Group). Although the total time for the colonoscopy was similar in the 3 groups(23.8 ± 0.7, 22.2 ± 0.5 and 24.1 ± 0.7 min for Groups A, B and C, respectively), it reached statistical significance between Groups B and C(P 0.05). The cecal intubation time in Groups B and C was longer than for Group A(6.5 ± 0.4 min and 6.5 ± 0.4 min vs 4.9 ± 0.3 min; P 0.05). The withdrawal time for Groups A and C was longer than Group B(18.9 ± 0.7 min and 17.6 ± 0.6min vs 15.7 ± 0.4 min; P 0.05). Overall miss rate for polyps and adenomas detected in three groups during the second look was 18% and 17%, respectively(P = NS). Detection rate for polyps and adenomas after first look with white light was similar irrespective of the light used during the second look(WL → WL: 13.7% for polyps, 12.6% for adenomas; WL → NBI: 14.2% for polyps, 11.3% for adenomas). Miss rate of polyps and adenomas however was significantly higher when NBI was used first(29.3% and 30.3%, respectively; P 0.05). Most missed adenomas were ≤ 5 mm in size. There was only one advanced neoplasia(defined by size only) missed during the first look. CONCLUSION: Our data suggest that the tandem nature of the procedure rather than the optical techniques was associated with the detection of additional polyps' and adenomas.     

自发荧光内镜与标准白光内镜在大肠息肉筛查中作用的对照研究

目的比较自发荧光内镜成像技术（AFI）模式下和标准白光技术（WL）模式下内镜对大肠息肉检出率的差异。方法对2008年12月至2009年8月间纳入的562例按照计算机随机数字表分成2组。A组在WL模式下进镜至盲肠后,用WL模式退镜检查至直肠,接着再次用WL模式进镜至盲肠,然后改用AFI模式退镜检查至直肠;B组退镜检查与A组顺序相反。在首次发现息肉时即取活检,以示标记,并记录下息肉的部位、大小及形态,所有活检标本送组织学检查以明确病理类型。结果在A组中,WL模式下先发现息肉78枚,AFI模式下新发现额外息肉28枚;在B组中,AFI模式下先发现息肉106枚,WL模式下新发现额外息肉20枚。对数据进行统计显示,AFI模式下内镜对息肉的漏诊率为15．9％（20／126）,显著低于WL模式下的26．4％（28／106）（P=0．041）。结论AFI内镜对于大肠息肉的筛查敏感性高,且操作简单易行,可推广应用。     

Esophageal adenocarcinoma with white opaque substance observed by magnifying endoscopy with narrow band imaging

White opaque substance (WOS) is observed in the gastric neoplasia of 0‐IIa type using magnifying endoscopy with narrow band imaging (NBI‐ME). Colonic and duodenal neoplasms with WOS have also been reported. Immunohistochemical examination with adipophilin reveals WOS in gastric neoplasms as lipid droplets, and WOS is specific for neoplasm with intestinal or gastrointestinal phenotype. We herein report a case of adenocarcinoma of the esophagogastric junction with WOS. A male patient in his sixties was found by esophagogastroduodenoscopy to have an esophageal elevated lesion. NBI‐ME showed whitish deposits that looked similar to WOS in gastric neoplasms. The patient underwent endoscopic submucosal dissection and the lesion was resected in a single piece. This tumor had diffuse positivity for adipophilin and gastrointestinal phenotype.     

普通白光联合窄带光成像放大内镜检查诊断早期胃癌浸润深度的模型研究

目的分析早期胃癌(EGC)黏膜下浸润的特征表现,通过联合白光内镜及窄带光成像结合放大内镜(ME-NBI)检查提高EGC浸润深度诊断的准确性。方法回顾性分析2015年1月至2017年12月期间因术前怀疑EGC于北京友谊医院行内镜黏膜下剥离术或外科手术治疗的患者资料。收集患者基本信息、病灶特征及术后病理等信息,分析EGC黏膜下浸润的特征、黏膜下浸润的独立危险因素,构建预测EGC浸润深度的模型。结果195例患者(207处病灶)纳入研究。207例病灶以2:1比例随机分为建模组(138处)及测试组(69处)。在建模组,病灶位于胃上1/3(0K=12.949,95%CZ:2.148~7&070,P=0.005),胃中1/3(OR=7.534,95%C/:1.044~54.360,P=0.045),病灶长径>2 cm(OR=6.828,95%C/:1.657~28.136,P=0.008)及存在扩张血管(OR=6.856,95%C/:1.577~29.805,P=0.010)是病灶黏膜下浸润的独立危险因素。根据上述独立危险因素构建浸润深度预测评分系统(DPSS)(病灶位于胃上1/3、病灶位于胃中1/3、病灶长径>2 cm、存在扩张血管各为5分、4分、4分、4分)。在建模组及测试组,DPSS预测病灶黏膜下浸润的受试者工作特征曲线下面积分别为0.884(95%C/:0.809-0.960)及0.799(95%C/:0.684~0.914)0界值为8分时,建模组及测试组诊断敏感度分别为83.3%、71.4%,特异度分别为76.2%,74.5%o结论联合普通白光内镜及ME-NBI建立的DPSS可以较好地预测EGC浸润深度。     

White light endoscopy, narrow band imaging and chromoendoscopy with magnification in diagnosing colorectal neoplasia

AIM: To evaluate the sensitivity (Sn), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of 3 different techniques: high resolution white light endoscopy (WLE), Narrow Band Imaging (NBI) and Chromoendoscopy (CHR), all with magnification in differentiating adenocarcinomas, adenomatous and hyperplastic colorectal polyps.METHODS: Each polyp was sequentially assessed first by WLE, followed by NBI and finally by CHR. Digital images of each polyp with each modality were taken and stored. Biopsies or polypectomies were then performed followed by blinded histopathological analysis. Each image was blindly graded based on the Kudo’s pit pattern (KPP). In the assessment with NBI, the mesh brown capillary network pattern (MBCN) of each polyp was also described. The Sn, Sp, PPV and NPV of differentiating hyperplastic (Type I & II-KPP, Type I-MBCN) adenomatous (Types III, IV-KPP, Type II-MBCN) and carcinomatous polyps (Type V-KPP, Type III-MCBN) was then compared with reference to the final histopathological diagnosis.RESULTS: A total of 50 colorectal polyps (5 adenocarcinomas, 38 adenomas, 7 hyperplastic) were assessed. CHR and NBI [KPP, MBCN or the combined classification (KPP & MBCN)] were superior to WLE in the prediction of polyp histology (P < 0.001, P = 0.002, P = 0.001 and P < 0.001, respectively). NBI, using the MBCN pattern or the combined classification showed higher numerical accuracies compared to CHR, but this was not statistically significant (P = 0.625, 0.250).CONCLUSION: This feasibility study demonstrated that this combined classification with NBI could potentially be useful in routine clinical practice, allowing the endoscopist to predict histology with higher accuracies using a less cumbersome and technically less challenging method.     

A feasibility trial of narrow band imaging endoscopy in patients with gastroesophageal reflux disease

BACKGROUND AND AIMS: Narrow band imaging (NBI) endoscopy system enhances visualization of microvasculature and mucosal patterns. This study assessed the utility of NBI in patients with gastroesophageal reflux disease (GERD) symptoms. METHODS: Patients with and without GERD symptoms completed 2 validated GERD questionnaires prior to enrollment. The distal esophagus was examined by standard white light endoscopy followed by NBI. The features seen only by NBI were compared between GERD patients and controls. RESULTS: Overall, 80 patients (50 GERD, 30 controls) were eligible for final analysis (mean age, 58.4 years; males, 93.7%; white, 82.5%). A significantly higher proportion of patients with GERD had increased number (OR, 12.6; 95% CI: 3.7-42; P < .0001), dilatation (OR, 20; 95% CI: 6.1-65.3; P < .0001), tortuosity of intrapapillary capillary loops (IPCLs) (OR, 6.9; 95% CI: 2.5-19; P < .0001), presence of microerosions (P < .0001), and increased vascularity at the squamocolumnar junction (OR, 9.3; 95% CI: 1.9-43.6; P = .001) compared with controls. On multivariate analysis, increased number (OR, 5.5; 95% CI: 1.4-21.6) and dilatation (OR, 11.3; 95% CI: 3.2-39.9) of IPCLs were the best predictors for diagnosing GERD. The maximum, minimum, and average number of IPCLs/field were significantly greater in the GERD group compared with controls (P < .0001). Although the interobserver agreement for the various NBI findings was very good, the intraobserver agreement was modest. CONCLUSIONS: NBI endoscopy may represent a significant improvement over standard endoscopy for the diagnosis of GERD. These preliminary findings including inter- and intraobserver agreement need to be evaluated in future prospective, controlled, and blinded GERD trials.     

Improving visualization techniques by narrow band imaging and magnification endoscopy

Endoscopy plays an important role in the early detection of gastrointestinal tract neoplasms. Using conventional white light or dye-based image enhanced endoscopy, it has been difficult to assess pre-malignant and early neoplastic lesions precisely. However, narrow band imaging (NBI) dramatically improves the detection of these lesions, particularly in combination with magnifying endoscopy. This allows the endoscopist to accomplish accurate diagnosis. Such enhanced detection of pre-malignant and early neoplastic lesions in the gastrointestinal tract should allow better targeting of biopsy, improved and more appropriate treatment, and thereby contribute to optimal quality of life and patient survival.     

超声引导下甲状腺结节细针穿刺术后病人舒适度的研究及护理对策

[目的]为了解超声引导下甲状腺结节细针穿刺(FNA)术后病人不舒适的相关因素,有针对性地加强对术后病人不舒适的护理。[方法]抽取本科8月份FNA术后病人136例,采用中文版舒适量表进行调查。内容包括一般资料、FNA检查的不适反应及程度。[结果]病人术后不舒适的原因有恶心、呕吐、头晕、喉咙痛等方面。检查期间轻度不适72.06%,中度不适24.26%,重度不适3.68%。[结论]针对病人不同程度的不适反应,制定具体的护理对策,实施相应的护理措施,有效解决病人的不适,减轻病人的恐惧心理,提升病人的舒适度。     

Magnifying endoscopy with narrow band imaging for diagnosis of colorectal tumors

BACKGROUND: Narrow band imaging (NBI) uses optical filters for red-green-blue sequential illumination and narrows the bandwidth of spectral transmittance. OBJECTIVE: This study aimed to clarify the clinical usefulness of NBI magnification in assessment of pit patterns for diagnosis of colorectal tumors. DESIGN: This was a retrospective study. SETTING: Department of Endoscopy, Hiroshima University Hospital. PATIENTS AND MAIN OUTCOME MEASUREMENTS: A total of 148 colorectal lesions, 16 hyperplasias, 84 tubular adenomas, and 48 early carcinomas were examined and diagnosed histologically. Mean size of lesions was 15.6+/-7.28 mm. Lesions were observed first under NBI magnification without chromoendoscopy and then under standard magnification with chromoendoscopy, and pit patterns were recorded. Results of NBI magnification were compared with those of standard magnification with chromoendoscopy to assess the clinical usefulness of NBI magnification for diagnosing colorectal neoplasia. RESULTS: Correspondence between the two diagnostic methods was 88% (14/16) for type II, 100% (2/2) for type IIIs, 98% (73/75) for type IIIl, 88% (7/8) for type IV, 78% (25/32) for type Vi, and 100% (3/3) for type Vn pit patterns. NBI depicted brownish change on the basis of surface capillaries in 6% (1/16) of hyperplasia and 99% (83/84) of tubular adenomas. This difference in color depiction was significant. LIMITATIONS: This study was performed in single center. CONCLUSIONS: Determination of pit patterns of colorectal neoplasias by NBI magnification was nearly the same as that by standard magnification with chromoendoscopy. Furthermore, NBI can distinguish neoplastic and nonneoplastic lesions without chromoendoscopy.     

普通窄带成像内镜对结直肠增生性息肉和腺瘤的鉴别诊断价值

目的 分析普通窄带成像(NBI)内镜下结直肠增生性息肉与腺瘤腺管及微血管特征的差异,评价NBI的鉴别诊断价值.方法 将普通内镜下诊断结直肠息肉、病理检查证实为增生性息肉或腺瘤者纳入研究并进行NBI内镜检查.将腺管形态参照改良的工藤分型法分为A型和B型.将微血管形态分为3型,无微血管判为Ⅰ型,微血管沿腺管开口排列、粗细均匀判为Ⅱ型,微血管粗细不均、排列紊乱判为Ⅲ型.比较增生性息肉和腺瘤NBI图像中腺管形态和微血管形态特征的差异,同时对无放大NBI图像观察者间的一致性进行评价.结果 共87例患者的107个息肉(腺瘤73个、增生性息肉34个)进行普通NBI内镜检查.腺瘤组息肉最大径和表面分叶者比例明显高于增生性息肉组(P值分别=0.0023和0.0047).腺瘤组中B型腺管形态[86.3％(63/73)]及Ⅱ或Ⅲ型微血管形态[82.2％(60/73)]者较多.以B型腺管形态、Ⅱ型或Ⅲ型微血管中任一特征诊断腺瘤的敏感度、特异度、准确率分别为97.3％、82.4％、92.5％.以B型腺管形态联合Ⅱ型或Ⅲ型微血管诊断腺瘤的敏感度、特异度、准确率分别为71.2％、91.2％、77.6％.观察者间一致性评价平均Kappa值为0.761.结论 普通NBI内镜下结直肠腺瘤和增生性息肉的微血管特征和腺管特征存在差异,依据以上两方面可在NBI内镜下实时初步鉴别腺瘤和增生性息肉.     

High-definition endoscopy and magnifying endoscopy combined with narrow band imaging in gastric cancer

Gastric cancer is the third common cancer and is the second leading cause of cancer deaths worldwide. Endoscopy is being increasingly used for gastric cancer screening because of a high detection rate. Despite promising data, the technique depends heavily on the availability of endoscopic instruments and expertise for mass screening. Furthermore, the introduction of various new endoscopic devices and techniques may enhance the value of endoscopy in efficacious cancer screening. High-definition endoscopy and image-enhanced endoscopy, including narrow band imaging, are the key modalities in advanced endoscopic imaging in gastric cancer.     

Two cases of adenocarcinoma occurring in sporadic fundic gland polyps observed by magnifying endoscopy with narrow band imaging

Gastric fundic gland polyps(FGPs) are common nonadenomatous gastric polyps arising from normal fundic mucosa without Helicobacter pylori(H. pylori) infection. Although systemic FGPs associated with familial adenomatous polyposis(FAP) often have dysplasia, there are few reports of dysplasia occurring in sporadic F G P s, e s p e c i a l l y w h e n d e t e c t e d b y m a g n i f y i n g endoscopy with narrow band imaging(ME-NBI). We experienced two cases of adenocarcinoma occurring in sporadic FGPs, and their ME-NBI findings were very useful for differentiating FGP with cancer from nondysplastic FGP. A 68-year-old man and a 63-year-old woman were referred to our institution for medical checkup. H. pylori was negative in both patients. Endoscopic examination revealed a small reddishpolypoid lesion on the anterior wall of the upper gastric body and several FGPs. ME-NBI showed an irregular microvascular architecture composed of closed loop- or open loop-type vascular components, plus an irregular microsurface structure composed of oval-type surface components which was different from that of FGPs. FAP was denied because of the absence of colon polyps and no familial history of FAP. Pathological diagnosis was adenocarcinoma occurring in sporadic FGP.     

窄带成像放大内镜下胃小凹形态观察的临床价值

目的探讨窄带成像放大内镜(NBI)技术下胃小凹的形态分型及其临床价值。方法应用窄带成像放大内镜技术对113例患者进行检查,观察胃小凹形态,并于各不同形态处行活组织检查。结果 A、B型胃小凹主要见于慢性浅表性胃炎,C、D、E型胃小凹主要见于慢性萎缩性胃炎,D、E型胃小凹与肠上皮化生及异型增生密切相关。结论通过窄带成像放大内镜对5种胃小凹的形态观察可以推测病理组织学诊断,使镜下准确诊断胃黏膜萎缩、肠上皮化生及异型增生成为可能,以指导正确的治疗方法及内镜下随诊。     

High definition versus standard definition white light endoscopy for detecting dysplasia in patients with Barrett's esophagus

High‐definition endoscopy systems provide superior image resolution. The aim of this study was to assess the utility of high definition compared with standard definition endoscopy system for detecting dysplastic lesions in patients with Barrett's esophagus. A retrospective cohort study of patients with non‐dysplastic Barrett's esophagus undergoing routine surveillance was performed. Data were retrieved from the central hospital electronic database. Procedures performed for non‐surveillance indications, Barrett's esophagus Prague C0M1 classification with no specialized intestinal metaplasia on histology, patients diagnosed with any dysplasia or cancer on index endoscopy, and procedures using advanced imaging techniques were excluded. Logistic regression models were constructed to estimate adjusted odds ratios and 95% confidence intervals comparing outcomes with standard definition and high‐definition systems. The high definition was superior to standard definition system in targeted detection of all dysplastic lesions (odds ratio 3.27, 95% confidence interval 1.27–8.40) as well as overall dysplasia detected on both random and target biopsies (odds ratio 2.36, 95% confidence interval 1.50–3.72). More non‐dysplastic lesions were detected with the high‐definition system (odds ratio 1.16, 95% confidence interval 1.01–1.33). There was no difference between high definition and standard definition endoscopy in the overall (random and target) high‐grade dysplasia or cancers detected (odds ratio 0.93, 95% confidence interval 0.83–1.04). Trainee endoscopists, number of biopsies taken, and male sex were all significantly associated with a higher yield for dysplastic lesions. The use of the high‐definition endoscopy system is associated with better targeted detection of any dysplasia during routine Barrett's esophagus surveillance. However, high‐definition endoscopy cannot replace random biopsies at present time.     

Meta-analysis for evaluating the accuracy of endoscopy with narrow band imaging in detecting colorectal adenomas

Background and Aim: The aim of this study was to determine whether the use of the narrow band imaging (NBI) system could enhance the accuracy of adenoma detection during an endoscopic examination of the colon and rectum. Methods: MEDLINE, EMBASE, and the Cochrane Library databases were searched along with a hand search of abstracts from relevant conferences up to June 2011. The rates of adenoma and flat adenoma detection, and withdrawal time were analyzed using Review Manager 4.2. Results: A total of 3049 subjects in eight trials were included. Meta‐analysis revealed that there was no statistically significant difference in the rates of adenoma detection between the NBI group and the white light colonoscopy group (pooled relative risk [RR]: 1.09, 95% confidence interval [CI]: 1.00–1.19, P = 0.05). However, after exclusion of high‐definition television modalities, the rate of adenoma detection by NBI was significantly higher than that by white light, particularly for patients with one adenoma (pooled RR 1.36, 95%CI 1.07–1.71, P = 0.02). Endoscopy with the NBI system significantly increased the rate of flat adenoma detection (pooled RR 1.96, 95%CI 1.09–3.52, P = 0.02). However, endoscopy with NBI had longer withdrawal time than that with white light (pooled weighted mean difference: 0.90, 95%CI: 0.38–1.42, P = 0.0006). Conclusions: Endoscopy with NBI seems to improve the detection of flat adenomas, particularly with high‐definition technology, but prolongs the withdrawal time. These results indicate that endoscopy routinely using the NBI system for the surveillance of adenomas may be recommended after the technique is further modified.     

High yields of small and flat adenomas with high-definition colonoscopes using either white light or narrow band imaging

BACKGROUND & AIMS: Detection of adenomas is an important goal of colonoscopy. Narrow band imaging (NBI) might highlight adenomas and lead to higher rates of adenoma detection. METHODS: This was a randomized controlled trial of colonoscopy withdrawal in white light versus NBI in 434 patients aged 50 years or older with intact colons. All examinations were performed by a single experienced endoscopist with a known high detection rate of adenomas using high-definition, wide-angle (170 degrees field of view) colonoscopes. RESULTS: There was no difference in the percent of patients with >or=1 adenoma for the entire cohort in white light (67%) versus NBI (65%) (P = .61) or in the subset of 257 patients with indication screening (58% vs 57%; P = .91). Both the prevalences of adenomas and the numbers of adenomas per colonoscopy are the highest ever reported in colonoscopy studies. The high prevalence rates of adenomas were accounted for by detection of large numbers of adenomas, including flat adenomas, which were 相似文献