Narrow band imaging and white light endoscopy in the characterization of a polypectomy scar: A single-blind observational study
|
摘要
AIM To assess the incremental benefit of narrow band imaging(NBI) and white light endoscopy(WLE), randomizing the initial technique for the detection of residual neoplasia at the polypectomy scar after an endoscopic piecemeal mucosal resection(EPMR).METHODS We conducted an observational study in an academic center to assess the incremental benefit of NBI and WLE randomly applied 1:1(NBI-WLE or WLE-NBI) in the follow-up of a post-EPMR scar by the same endoscopist.RESULTS A total of 112 EPMR scars were included. The median baseline polyp size was 20 mm(interquartile range: 14-30). At first review, NBI and WLE showed good sensitivity(85.0% vs 78.9%), specificity(77.1% vs 84.2%) and overall accuracy(80.0% vs 82.5%). NBI after WLE(WLE-NBI group) improved accuracy, but this difference was not statistically significant [area under the curve(AUC): 86.8% vs 81.6%, P = 0.15]. WLE after NBI(NBI-WLE group) did not improve accuracy(AUC: 81.4% vs 81.1%, P = 0.9). Overall, recurrence was found in 39/112(34.8%) lesions.CONCLUSION Although no statistically significant differences were found between the two techniques at the first postEPMR assessment, the use of NBI after WLE may improve residual neoplasia detection. Nevertheless, biopsy is still required in the first scar review.
AIM To assess the incremental benefit of narrow band imaging(NBI) and white light endoscopy(WLE), randomizing the initial technique for the detection of residual neoplasia at the polypectomy scar after an endoscopic piecemeal mucosal resection(EPMR).METHODS We conducted an observational study in an academic center to assess the incremental benefit of NBI and WLE randomly applied 1:1(NBI-WLE or WLE-NBI) in the follow-up of a post-EPMR scar by the same endoscopist.RESULTS A total of 112 EPMR scars were included. The median baseline polyp size was 20 mm(interquartile range: 14-30). At first review, NBI and WLE showed good sensitivity(85.0% vs 78.9%), specificity(77.1% vs 84.2%) and overall accuracy(80.0% vs 82.5%). NBI after WLE(WLE-NBI group) improved accuracy, but this difference was not statistically significant [area under the curve(AUC): 86.8% vs 81.6%, P = 0.15]. WLE after NBI(NBI-WLE group) did not improve accuracy(AUC: 81.4% vs 81.1%, P = 0.9). Overall, recurrence was found in 39/112(34.8%) lesions.CONCLUSION Although no statistically significant differences were found between the two techniques at the first postEPMR assessment, the use of NBI after WLE may improve residual neoplasia detection. Nevertheless, biopsy is still required in the first scar review.
AIM To assess the incremental benefit of narrow band imaging(NBI) and white light endoscopy(WLE), randomizing the initial technique for the detection of residual neoplasia at the polypectomy scar after an endoscopic piecemeal mucosal resection(EPMR).METHODS We conducted an observational study in an academic center to assess the incremental benefit of NBI and WLE randomly applied 1:1(NBI-WLE or WLE-NBI) in the follow-up of a post-EPMR scar by the same endoscopist.RESULTS A total of 112 EPMR scars were included. The median baseline polyp size was 20 mm(interquartile range: 14-30). At first review, NBI and WLE showed good sensitivity(85.0% vs 78.9%), specificity(77.1% vs 84.2%) and overall accuracy(80.0% vs 82.5%). NBI after WLE(WLE-NBI group) improved accuracy, but this difference was not statistically significant [area under the curve(AUC): 86.8% vs 81.6%, P = 0.15]. WLE after NBI(NBI-WLE group) did not improve accuracy(AUC: 81.4% vs 81.1%, P = 0.9). Overall, recurrence was found in 39/112(34.8%) lesions.CONCLUSION Although no statistically significant differences were found between the two techniques at the first postEPMR assessment, the use of NBI after WLE may improve residual neoplasia detection. Nevertheless, biopsy is still required in the first scar review.
引文
1 Burgess NG,Bahin FF,Bourke MJ.Colonic polypectomy(with videos).Gastrointest Endosc 2015;81:813-835[PMID:25805461DOI:10.1016/j.gie.2014.12.027]
2 Moss A,Williams SJ,Hourigan LF,Brown G,Tam W,Singh R,Zanati S,Burgess NG,Sonson R,Byth K,Bourke MJ.Long-term adenoma recurrence following wide-field endoscopic mucosal resection(WF-EMR)for advanced colonic mucosal neoplasia is infrequent:results and risk factors in 1000 cases from the Australian Colonic EMR(ACE)study.Gut 2015;64:57-65[PMID:24986245DOI:10.1136/gutjnl-2013-305516]
3 Khashab M,Eid E,Rusche M,Rex DK.Incidence and predictors of“late”recurrences after endoscopic piecemeal resection of large sessile adenomas.Gastrointest Endosc 2009;70:344-349[PMID:19249767 DOI:10.1016/j.gie.2008.10.037]
4 Buchner AM,Guarner-Argente C,Ginsberg GG.Outcomes of EMR of defiant colorectal lesions directed to an endoscopy referral center.Gastrointest Endosc 2012;76:255-263[PMID:22657404DOI:10.1016/j.gie.2012.02.060]
5 Atkin WS,Valori R,Kuipers EJ,Hoff G,Senore C,Segnan N,Jover R,Schmiegel W,Lambert R,Pox C;International Agency for Research on Cancer.European guidelines for quality assurance in colorectal cancer screening and diagnosis.First Edition--Colonoscopic surveillance following adenoma removal.Endoscopy2012;44 Suppl 3:SE151-SE163[PMID:23012119 DOI:10.1055/s-0032-1309821]
6 Lieberman DA,Rex DK,Winawer SJ,Giardiello FM,Johnson DA,Levin TR.Guidelines for colonoscopy surveillance after screening and polypectomy:a consensus update by the US Multi-Society Task Force on Colorectal Cancer.Gastroenterology 2012;143:844-857[PMID:22763141 DOI:10.1053/j.gastro.2012.06.001]
7 Machida H,Sano Y,Hamamoto Y,Muto M,Kozu T,Tajiri H,Yoshida S.Narrow-band imaging in the diagnosis of colorectal mucosal lesions:a pilot study.Endoscopy 2004;36:1094-1098[PMID:15578301 DOI:10.1055/s-2004-826040]
8 Hurlstone DP,Sanders DS,Cross SS,Adam I,Shorthouse AJ,Brown S,Drew K,Lobo AJ.Colonoscopic resection of lateral spreading tumours:a prospective analysis of endoscopic mucosal resection.Gut 2004;53:1334-1339[PMID:15306595 DOI:10.1136/gut.2003.036913]
9 Rogart JN,Aslanian HR,Siddiqui UD.Narrow band imaging to detect residual or recurrent neoplastic tissue during surveillance endoscopy.Dig Dis Sci 2011;56:472-478[PMID:20532981 DOI:10.1007/s10620-010-1289-z]
10 Kamiński MF,Hassan C,Bisschops R,Pohl J,PelliséM,Dekker E,Ignjatovic-Wilson A,Hoffman A,Longcroft-Wheaton G,Heresbach D,Dumonceau JM,East JE.Advanced imaging for detection and differentiation of colorectal neoplasia:European Society of Gastrointestinal Endoscopy(ESGE)Guideline.Endoscopy 2014;46:435-449[PMID:24639382 DOI:10.1055/s-0034-1365348]
11 Desomer L,Tutticci N,Tate DJ,Williams SJ,McLeod D,Bourke MJ.A standardized imaging protocol is accurate in detecting recurrence after EMR.Gastrointest Endosc 2017;85:518-526[PMID:27343411 DOI:10.1016/j.gie.2016.06.031]
12 Lai EJ,Calderwood AH,Doros G,Fix OK,Jacobson BC.The Boston bowel preparation scale:a valid and reliable instrument for colonoscopy-oriented research.Gastrointest Endosc 2009;69:620-625[PMID:19136102 DOI:10.1016/j.gie.2008.05.057]
13 ASGE Technology Committee.High-definition and highmagnification endoscopes.Gastrointest Endosc 2014;80:919-927[PMID:25442091 DOI:10.1016/j.gie.2014.06.019]
14 The Paris endoscopic classification of superficial neoplastic lesions:esophagus,stomach,and colon:November 30 to December 1,2002.Gastrointest Endosc 2003;58:S3-S43[PMID:14652541 DOI:10.1016/S0016-5107(03)02159-X]
15 Hewett DG,Kaltenbach T,Sano Y,Tanaka S,Saunders BP,Ponchon T,Soetikno R,Rex DK.Validation of a simple classification system for endoscopic diagnosis of small colorectal polyps using narrow-band imaging.Gastroenterology 2012;143:599-607.e1[PMID:22609383 DOI:10.1053/j.gastro.2012.05.006]
16 Sakamoto T,Matsuda T,Otake Y,Nakajima T,Saito Y.Predictive factors of local recurrence after endoscopic piecemeal mucosal resection.J Gastroenterol 2012;47:635-640[PMID:22223177DOI:10.1007/s00535-011-0524-5]
17 Landis JR,Koch GG.The measurement of observer agreement for categorical data.Biometrics 1977;33:159-174[PMID:843571DOI:10.2307/2529310]
18 Knabe M,Pohl J,Gerges C,Ell C,Neuhaus H,Schumacher B.Standardized long-term follow-up after endoscopic resection of large,nonpedunculated colorectal lesions:a prospective two-center study.Am J Gastroenterol 2014;109:183-189[PMID:24343549DOI:10.1038/ajg.2013.419]
19 Sreepati G,Vemulapalli KC,Rex DK.Clip artifact after closure of large colorectal EMR sites:incidence and recognition.Gastrointest Endosc 2015;82:344-349[PMID:25843616 DOI:10.1016/j.gie.2014.12.059]
20 PelliséM,Desomer L,Burgess NG,Williams SJ,Sonson R,Mc Leod D,Bourke MJ.The influence of clips on scars after EMR:clip artifact.Gastrointest Endosc 2016;83:608-616[PMID:26364966 DOI:10.1016/j.gie.2015.08.071]
21 Belderbos TD,Leenders M,Moons LM,Siersema PD.Local recurrence after endoscopic mucosal resection of nonpedunculated colorectal lesions:systematic review and meta-analysis.Endoscopy 2014;46:388-402[PMID:24671869 DOI:10.1055/s-0034-1364970]
22 Tate DJ,Desomer L,Klein A,Brown G,Hourigan LF,Lee EY,Moss A,Ormonde D,Raftopoulos S,Singh R,Williams SJ,Zanati S,Byth K,Bourke MJ.Adenoma recurrence after piecemeal colonic EMR is predictable:the Sydney EMR recurrence tool.Gastrointest Endosc 2017;85:647-656.e6[PMID:27908600 DOI:10.1016/j.gie.2016.11.027]
2 Moss A,Williams SJ,Hourigan LF,Brown G,Tam W,Singh R,Zanati S,Burgess NG,Sonson R,Byth K,Bourke MJ.Long-term adenoma recurrence following wide-field endoscopic mucosal resection(WF-EMR)for advanced colonic mucosal neoplasia is infrequent:results and risk factors in 1000 cases from the Australian Colonic EMR(ACE)study.Gut 2015;64:57-65[PMID:24986245DOI:10.1136/gutjnl-2013-305516]
3 Khashab M,Eid E,Rusche M,Rex DK.Incidence and predictors of“late”recurrences after endoscopic piecemeal resection of large sessile adenomas.Gastrointest Endosc 2009;70:344-349[PMID:19249767 DOI:10.1016/j.gie.2008.10.037]
4 Buchner AM,Guarner-Argente C,Ginsberg GG.Outcomes of EMR of defiant colorectal lesions directed to an endoscopy referral center.Gastrointest Endosc 2012;76:255-263[PMID:22657404DOI:10.1016/j.gie.2012.02.060]
5 Atkin WS,Valori R,Kuipers EJ,Hoff G,Senore C,Segnan N,Jover R,Schmiegel W,Lambert R,Pox C;International Agency for Research on Cancer.European guidelines for quality assurance in colorectal cancer screening and diagnosis.First Edition--Colonoscopic surveillance following adenoma removal.Endoscopy2012;44 Suppl 3:SE151-SE163[PMID:23012119 DOI:10.1055/s-0032-1309821]
6 Lieberman DA,Rex DK,Winawer SJ,Giardiello FM,Johnson DA,Levin TR.Guidelines for colonoscopy surveillance after screening and polypectomy:a consensus update by the US Multi-Society Task Force on Colorectal Cancer.Gastroenterology 2012;143:844-857[PMID:22763141 DOI:10.1053/j.gastro.2012.06.001]
7 Machida H,Sano Y,Hamamoto Y,Muto M,Kozu T,Tajiri H,Yoshida S.Narrow-band imaging in the diagnosis of colorectal mucosal lesions:a pilot study.Endoscopy 2004;36:1094-1098[PMID:15578301 DOI:10.1055/s-2004-826040]
8 Hurlstone DP,Sanders DS,Cross SS,Adam I,Shorthouse AJ,Brown S,Drew K,Lobo AJ.Colonoscopic resection of lateral spreading tumours:a prospective analysis of endoscopic mucosal resection.Gut 2004;53:1334-1339[PMID:15306595 DOI:10.1136/gut.2003.036913]
9 Rogart JN,Aslanian HR,Siddiqui UD.Narrow band imaging to detect residual or recurrent neoplastic tissue during surveillance endoscopy.Dig Dis Sci 2011;56:472-478[PMID:20532981 DOI:10.1007/s10620-010-1289-z]
10 Kamiński MF,Hassan C,Bisschops R,Pohl J,PelliséM,Dekker E,Ignjatovic-Wilson A,Hoffman A,Longcroft-Wheaton G,Heresbach D,Dumonceau JM,East JE.Advanced imaging for detection and differentiation of colorectal neoplasia:European Society of Gastrointestinal Endoscopy(ESGE)Guideline.Endoscopy 2014;46:435-449[PMID:24639382 DOI:10.1055/s-0034-1365348]
11 Desomer L,Tutticci N,Tate DJ,Williams SJ,McLeod D,Bourke MJ.A standardized imaging protocol is accurate in detecting recurrence after EMR.Gastrointest Endosc 2017;85:518-526[PMID:27343411 DOI:10.1016/j.gie.2016.06.031]
12 Lai EJ,Calderwood AH,Doros G,Fix OK,Jacobson BC.The Boston bowel preparation scale:a valid and reliable instrument for colonoscopy-oriented research.Gastrointest Endosc 2009;69:620-625[PMID:19136102 DOI:10.1016/j.gie.2008.05.057]
13 ASGE Technology Committee.High-definition and highmagnification endoscopes.Gastrointest Endosc 2014;80:919-927[PMID:25442091 DOI:10.1016/j.gie.2014.06.019]
14 The Paris endoscopic classification of superficial neoplastic lesions:esophagus,stomach,and colon:November 30 to December 1,2002.Gastrointest Endosc 2003;58:S3-S43[PMID:14652541 DOI:10.1016/S0016-5107(03)02159-X]
15 Hewett DG,Kaltenbach T,Sano Y,Tanaka S,Saunders BP,Ponchon T,Soetikno R,Rex DK.Validation of a simple classification system for endoscopic diagnosis of small colorectal polyps using narrow-band imaging.Gastroenterology 2012;143:599-607.e1[PMID:22609383 DOI:10.1053/j.gastro.2012.05.006]
16 Sakamoto T,Matsuda T,Otake Y,Nakajima T,Saito Y.Predictive factors of local recurrence after endoscopic piecemeal mucosal resection.J Gastroenterol 2012;47:635-640[PMID:22223177DOI:10.1007/s00535-011-0524-5]
17 Landis JR,Koch GG.The measurement of observer agreement for categorical data.Biometrics 1977;33:159-174[PMID:843571DOI:10.2307/2529310]
18 Knabe M,Pohl J,Gerges C,Ell C,Neuhaus H,Schumacher B.Standardized long-term follow-up after endoscopic resection of large,nonpedunculated colorectal lesions:a prospective two-center study.Am J Gastroenterol 2014;109:183-189[PMID:24343549DOI:10.1038/ajg.2013.419]
19 Sreepati G,Vemulapalli KC,Rex DK.Clip artifact after closure of large colorectal EMR sites:incidence and recognition.Gastrointest Endosc 2015;82:344-349[PMID:25843616 DOI:10.1016/j.gie.2014.12.059]
20 PelliséM,Desomer L,Burgess NG,Williams SJ,Sonson R,Mc Leod D,Bourke MJ.The influence of clips on scars after EMR:clip artifact.Gastrointest Endosc 2016;83:608-616[PMID:26364966 DOI:10.1016/j.gie.2015.08.071]
21 Belderbos TD,Leenders M,Moons LM,Siersema PD.Local recurrence after endoscopic mucosal resection of nonpedunculated colorectal lesions:systematic review and meta-analysis.Endoscopy 2014;46:388-402[PMID:24671869 DOI:10.1055/s-0034-1364970]
22 Tate DJ,Desomer L,Klein A,Brown G,Hourigan LF,Lee EY,Moss A,Ormonde D,Raftopoulos S,Singh R,Williams SJ,Zanati S,Byth K,Bourke MJ.Adenoma recurrence after piecemeal colonic EMR is predictable:the Sydney EMR recurrence tool.Gastrointest Endosc 2017;85:647-656.e6[PMID:27908600 DOI:10.1016/j.gie.2016.11.027]