Detection Of Colorectal Neoplasms And Non-neoplams By Colonoscopy:a Randomized Controlled Comparison Of Routine Endoscopy,narrow Band Imaging With Magnifying Endoscopy And Magnifying Chromoendoscopy

Objective:To observe capillary pattern(CP)on the surface of lesions un-der narrow band imaging(NBI)with magnifying endoscopy,and pit pattern(PP) under magnifying chromoendoscopy;To compare the diagnostic efficacies of routine endoscopy,narrow band imaging with magnifying endosco-py(NBI-ME)and magnifying chromoendoscopy in distinguishing colorectal neoplasms from non-neoplams;To compare the operation time of NBI-ME and magnifying chromoendoscopy.Methods:Patients,aged from 22 to 76,examined by routine endoscopy in Tangshan Gongren Hospital of the Hebei Medical University form Sep-tember to Nevember in 2014,and found colorectal neoplasm or polypoid le-sions,willing to accept examinations by NBI-ME and magnifying chromoen-doscopy and pathology,were enrolled in the study.They were informed the ne-cessity and and possible risks before colonoscopy and signed the informed consent.The intestinal preparation based on the "Guide of gastrointestinal endoscopy related intestinal preparation in China(Draft)".All endoscopic op-erations were performed by a experienced endoscopist with Olympus CF-H260 ZI.The colonoscopy were advanced to the ileocecal by single per-son operation, where was confirmed by the appendiceal orifice and the ileo-cecal valve. When abnormal mucosa was found, withdraw the endoscope in the white light and NBI sequentially as following :(1) Evaluate whether it was neoplasm or not under the routine model and recording the gross mor-phology.If lesion was found in NBI model,switching to routine model.(2) Turn to the NBI model through the panel switching, adjust the zoom button to 40-100 times, observe and classify the capillary pattern according to the Sano classification,and then record the time consumption in this step.(3)Switch to normal model, stain lesions by the spraying indicarmine though biop-sy hole, adjust the zoom button to 40-100 times, and observe the PP and clas-sify them according to Kudo pit pattern lassification.Record the operation time in this step.(4)Cut off the lesion or conduct punch multiple biopsy and patho-logical examination. Statistical analysis was performed using SPSS13.0 statis-tical software, and statistics were compared by χ2 test and t test. Difference was satistical significant when P<0.05.Results:1 Rate of detectionIn the study,Six hundred and twelve patients, aged from 22 to 76,were examined by routine endoscopy in Tangshan Gongren Hospital of the Hebei Medical University form September to October in 2014. Ninety-four patients were enrolled in the study who were found colorectal neoplasm or polypoid lesions and were willing to accept examinations by NBI-ME and magnifying chromoendoscopy and pathology.Lesion in 131 cases were found by routine endoscopy,and 146 cases by NBI-ME.The flat lesions were mainly missed under routine mode.2 The pathologic resultAll pathological results were divided into neoplasms and non-neoplams.The former include adenomas(51 cases of tubular adenomas, 15 cases of villous adenoma,8 of tubulovillous adenoma and 1case of serrated adenomas) and adenocarcinoma(19 cases),while the non-neoplams include in-flammatory and hyperplastic lesions(52 cases).3 Comparison of endoscopic diagnosis by routine endoscopy,NBI-ME, magnifying chromoendoscopy with pathologic diagnosisAccording to the Sano CP classification and Kudo pit pattern classifica-tion,comparing the endoscopic diagnosis and pathological diagnosis, The di-agnostic accuracy of NB-MEI in distinguishing neoplastic from non-neoplastic colorectal lesions was 90.4%(132/146),the sensitivity 94.6%, the specificity 82.7%,and the magnifying chromoendoscopy was 91.8%(134/146),92.6%,90.4%.No significant difference was detected between the two methods(P>0.05).But they were higher than that of routine colonos-copy(79.4%,74.6%,84.4%)(P<0.05).4 Operation timeThe operation time of NBI-ME was 63.86±5.40 s,while magnifying chromoendoscopy was longer.(118.75±16.81 s, P<0.05)Conclusion:1 NBI had a higher detection rate of lesions than routine endoscopy.2 In distinguishing colorectal neoplasms from non-neoplams, the diag-nostic efficacies of NBI-ME and magnifying chromoendoscopy was consis-tent,but they were significantly higher than that of routine endoscopy;3 The operation time of NBI-ME was significantly shorter than that of magnifying chromoendoscopy.