Autofluorescence imaging with a transparent hood for detection of colorectal neoplasms: a prospective, randomized trial

作者：Takeuchi Yoji^*; Inoue Takuya; Hanaoka Noboru; Higashino Koji; Iishi Hiroyasu; Chatani Rika; Hanafusa Masao; Kizu Takashi; Ishihara Ryu; Tatsuta Masaharu; Shimokawa Toshio; Uedo Noriya

来源：Gastrointestinal Endoscopy, 2010, 72(5): 1006-1013.

DOI：10.1016/j.gie.2010.06.055

Background: Colonoscopy is one of the most reliable methods for detection of colorectal neoplasms, but conventional colonoscopy can miss some lesions.
Objective: To evaluate the efficacy of autofluorescence imaging (AFI) with a transparent hood (TH) for detection of colorectal neoplasms.
Design: A 2 x 2 factorial designed, prospective, randomized, controlled trial.
Setting: This study was conducted at the Osaka Medical Center for Cancer and Cardiovascular Diseases, a tertiary cancer center.
Patients: A total of 561 patients.
Interventions: Patients were allocated to 1 of 4 groups: (1) white light imaging (WLI) alone-colonoscopy using WLI without a TH; (2) WLI+TH-colonoscopy using WLI with a TH; (3) AFI alone-colonoscopy using AFI without a TH; and (4) AFI+TH-colonoscopy using AFI with a TH. Eight colonoscopists used each allocated method.
Main Outcome Measurement: The difference in neoplasm detection rate (number of detected neoplasms per patient) between the WLI alone and AFI + TH groups.
Results: Neoplasm detection rate (95% confidence interval) in the AFI+TH group was significantly higher than in the WLI alone group (1.96 [1.50-2.43] vs 1.19 [0.93-1.44]; P = .023, Tukey-Kramer multiple comparison test). Relative detection ratios (95% confidence interval) for polypoid neoplasms based on Poisson regression model were significantly increased by mounting a TH (1.69 [1.34-2.12], P < .001), and relative detection ratios for flat neoplasms were significantly increased by AFI observation (1.83 [1.24-2.71], P = .002).
Limitations: Open trial performed in single cancer referral center.
Conclusion: AFI colonoscopy with a TH detected significantly more colorectal neoplasms than did conventional WLI colonoscopy without a TH. (Clinical trial registration number: UMIN000001473.) (Gastrointest Endosc 2010;72:1006-13.)

• 出版日期2010-11