注气与注水肠镜下结直肠息肉的内镜形态与病理关系的比较

Comparison of endoscopic morphologic characteristics and pathologic types of colorectal polyps between gas and water injection colonoscopies

目的:比较注气与注水结肠镜下结直肠息肉的内镜形态特征与病理类型之间的关系。方法:选取2018年9月至2019年6月于福建省肿瘤医院在非放大内镜窄带成像(narrow-band imaging,NBI)模式下62例接受注气肠镜与53例注水肠镜检查发现的结直肠息肉进行观察,分析病变的血管形态及表面的结构,应用国际结直肠内镜分型(NICE)实时预测病理类型,并将NBI内镜诊断结果与病理组织学诊断结果进行分析,比较两组的敏感度、特异度、准确率以及扁平息肉(即巴黎分型0~Ⅱa型)的检出率。结果:注水组扁平状息肉检出率为44.64%,其中左半、右半结肠检出率分别为26.78%、17.86%;注气组为40.00%,左半、右半结肠检出率分别35.56%、4.44%;两组检查结果差异具有统计学意义(P<0.01)。NICE分型实时预测结直肠息肉病变总的敏感度、特异度、准确率分别为91.95%、96.61%、93.84%,其中注气组的分别为90.74%、97.27%、93.33%,注水组的分别为93.93%、95.65%、94.64%,并发现2例无蒂锯齿状腺瘤(sessile serrated adenoma,SSA),两组检查结果差异无统计学意义。结论:注气肠镜与注水肠镜预测结直肠息肉的病理类型准确性无显著性差异,但注水肠镜能提高右半结肠0~Ⅱa型息肉的检出。

Objective: To compare endoscopic morphologic characteristics and pathologic types of colorectal polyps between gas and water injection colonoscopies. Methods: Using the magnifying endoscopy narrow-band imaging(NBI) mode in 62 cases of gas injection colonoscopy and 53 cases of water injection colonoscopy for colorectal polyps in Fujian Provincial Cancer Hospital, the pathologic changes in vascular morphology and surface structure, application of international colorectal endoscopic classification(NICE) pathologic types, real-time prediction, and NBI endoscopic and pathologic histology diagnosis results were analyzed. Furthermore, the sensitivity, accuracy, and detection rates of flat polyps(Paris type 0-IIa) for both procedures were compared. Results: The detection rate of flat polyps in the water injection group was 44.64%, and the detection rates of the left and right hemicolon were 26.78% and 17.86%, respectively. The detection rate of flat polyps in the gas injection group was 40.00%, and the detection rates of the left and right hemicolon were 35.56% and 4.44%, respectively. The difference in detection rates between the two groups was statistically significant. The diagnostic sensitivity, specificity, and accuracy of overall NICE classification for colorectal neoplastic lesions were 91.95%, 96.61%, and93.84%, respectively. The sensitivity, specificity, and accuracy of the gas injection enteroscopy group were 90.74%, 97.27%, and93.33%, respectively, and those of the water injection enteroscopy group were 93.93%, 95.65%, and 94.64%, respectively. Two cases of sessile serrated adenoma were also found. There was no statistically significant difference in the examination results between the two groups. Conclusions: The accuracy of gas or water injection colonoscopy did not significantly differ in predicting the pathologic types of colorectal polyps. However, water injection colonoscopy can improve the detection of 0-IIa polyps in the right colon.