Chromoscopy versus conventional endoscopy for the detection of polyps in the colon and rectum

 

Abstract

Background

Although conventional colonoscopy is the most sensitive test available for the investigation of the colorectum for polyps, there are data that raise concerns about its sensitivity. Chromoscopy may be one way of enhancing the ability for colonoscopy to detect polyps particularly diminutive flat lesions that may be otherwise difficult to detect.

Objectives

To determine whether the use of chromoscopy enhances detection of polyps and neoplasia during endoscopic examination of the colon and rectum.

Search methods

MEDLINE, EMBASE and the Cochrane Library databases were searched (April 2010) along with a hand search of abstracts from relevant meetings. Search terms included randomised trials containing combinations of the following: 'chromoscopy' 'colonoscopy' 'dye-spray' 'chromo-endoscopy' 'indigo-carmine' 'magnifying endoscopy'.

Selection criteria

All prospective randomised trials comparing chromoscopic with conventional endoscopic examination of the lower gastrointestinal tract were included. Patients with inflammatory bowel disease or polyposis syndromes were excluded.

Data collection and analysis

Two reviewers assessed the methodological quality of potentially eligible trials and independently extracted data from the included trials. Outcome measures included the detection of polyps (neoplastic and non-neoplastic), the detection of diminutive lesions, the number of patients with multiple neoplastic lesions and the extubation time.

Main results

Five trials were included in this update, and although there were some methodological drawbacks and differences in study design, combining the results showed a significant difference in favour of chromoscopy for all detection outcomes. In particular, chromoscopy is likely to yield significantly more patients with at least one neoplastic lesion (OR 1.67 (CI 1.29-2.15)) and significantly more patients with three or more neoplastic lesions (OR 2.55 (CI 1.49-4.36)). Not surprisingly the withdrawal times were significantly slower for the chromoscopy group.

Authors' conclusions

There appears to be strong evidence that chromoscopy enhances the detection of neoplasia in the colon and rectum. Patients with neoplastic polyps, particularly those with multiple polyps, are at increased risk of developing colorectal cancer. Such lesions, which presumably would be missed with conventional colonoscopy, could contribute to the interval cancer numbers on any surveillance programme.

 

Plain language summary

Chromoscopic colonoscopy enhances polyp detection compared with conventional colonoscopy

Colonoscopy is a diagnostic test that enables small growths in the bowel (polyps) to be detected. These lesions can develop into cancer in approximately 5% of the cases. Although the test is the most sensitive test that exists for the detection of these growths, some may be missed. If a simple dye spraying technique (chromoscopy) is used with the colonoscopic test, the detection of these lesions may be enhanced. Several studies have examined the effect of chromoscopy on enhancing polyp detection but the data is inconsistent. This review investigated whether chromoscopy can enhance polyp detection compared with conventional colonoscopy.

Five randomised trials with a total of 1059 participants were included. Despite differences within the study designs there appears to be strong evidence that chromoscopic colonoscopy enhances the detection of polyps in the colon and rectum.  

 

摘要

背景

Chromoscopy 與常規內視鏡發現結腸和直腸息肉的比較

雖然用於調查結直腸息肉常規結腸鏡檢查是最敏感試驗,有數據引起敏感度的關切. Chromoscopy可能是提高的大腸鏡檢查發現息肉病變方法之一，尤其是微型扁平病變，否則可能很難察覺。

目標

要確定是否使用chromoscopy內視鏡檢查結腸和直腸的期間,提高了息肉及腫瘤的發現。

搜尋策略

MEDLINE，EMBASE和Cochrane圖書館的數據庫連同從有關會議手查文摘被搜查。 搜索範圍包括含隨機試驗的組合如下：‘chromoscopy’結腸鏡染料噴(dyespray) ‘chromoendoscopy’ ‘indigocarmine’ ‘magnifying endoscopy’。

選擇標準

所有前瞻性隨機試驗,在比較包括下消化道在內的chromoscopic及常規內鏡檢查。 患者有發炎性腸道疾病或症狀性息肉排除在外.

資料收集與分析

三位評審評估了潛在合格試驗的方法質量學,和納入試驗獨立提取數據.結果措施包括檢測息肉(腫瘤和非腫瘤性),檢測微型病變,患者的數目為多發性腫瘤性病變.

主要結論

四個試驗包括符合納入標準，雖然在研究設計上有一些缺點和分歧的方法，結合所有檢測結果顯示顯著性差異chromoscopy較優.特別是，chromoscopy有可能產生更多的患者至少有一個腫瘤病灶.(OR 1.61 (CI 1.24 – 2.09))與更多的患者有3個或更多的腫瘤性病變(OR 2.55 (CI 1.49 – 4.36)),毫無疑問的chromoscopy組的戒斷時間顯著的比較慢.

作者結論

強而有力的證據證明, chromoscopy 提高了結腸和直腸的腫瘤檢測.腫瘤息肉患者,特別是多個的息肉,正處於發展成結直腸癌的風險增加中.這種病變,常規結腸鏡檢查大概會錯過,在監察計畫中有助於區隔癌症患者.

翻譯人

本摘要由國泰綜合醫院張世昌翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

結腸鏡檢查是診斷性的測試,它能讓小的生長在腸道(息肉)被檢測到.這些病變是癌症的前兆.雖然這是檢測周圍的生長最敏感的測試,有些仍可能會錯過.如果於結腸鏡測試中用簡單染料噴塗技術,顯示能加強檢測病變.這可能使結腸鏡檢查更敏感.