注水与注气肠镜+非放大NBI下NICE分型对于结直肠小息肉内镜下治疗的临床价值

Clinical value of NICE typing under water injection and gas injection colonoscopy plus non-magnifying narrow-band imaging for endoscopic treatment of small colorectal polyps

目的:比较注水与注气结肠镜下非放大窄带成像(NBI)下NICE分型对于结直肠小息肉的诊断价值。方法:回顾性选取449枚结直肠小息肉,其中176枚为注水法肠镜下发现(注水组),273枚为注气法肠镜下发现(注气组)。观察2组病人留取的非放大NBI图像,应用NICE分型预判病理类型,并与病理检查结果进行分析对比。结果:2组腺瘤检出率差异无统计学意义(P>0.05),注水组扁平息肉检出率高于注气组(P<0.05)。经验丰富的内镜医生对NICE分型诊断结果一致性较高(Kappa值=0.807),对注水组和注气组非放大NBI下NICE分型诊断的敏感性、特异性、准确率分别为97.0%(128/132)、81.8%(36/44)、94.3%(166/176)和98.6%(216/219)、72.0%(39/54)、93.4%(255/273)。初学者对注水组和注气组非放大NBI下NICE分型诊断的敏感性、特异性、准确率分别为51.5%(68/132)、72.7%(32/44)、56.8%(100/176)和46.1%(101/219)、63.0%(34/54)、49.5%(135/273)。初学者和经验丰富的内镜医生对2组NICE分型诊断结果一致性均较低(Kappa值=0.199、0.076)。结论:无论注水还是注气条件,经验丰富的内镜医生以非放大NBI下NICE分型能够很好地区分肿瘤性、非肿瘤性结直肠小息肉,诊断价值高,对于日间病房的息肉治疗策略有很好的指导意义。

Objective:To compare the diagnostic value of NICE typing under water injection and gas injection colonoscopy plus non-magnifying narrow-band imaging(NBI)in small colorectal polyps.Methods:A total of 449 small colorectal polyps were enrolled in this study.Among them,176 cases were found by water injection colonoscopy(water injection group),and 273 cases were found by gas injection colonoscopy(gas injection group).Each lesion was observed by non-magnifying NBI,and the histology was predicted and compared according to NICE typing system.Results:There was no statistically significant difference in the examination results in the colorectal adenoma detection rate between the two groups(P>0.05),and the detection rate of flat polyps in the water injection group was higher than that in the gas injection group(P<0.05).Experienced endoscopists had a high consistency in the diagnosis results of NICE typing(κ=0.807).The sensitivity,specificity and accuracy of NICE typing under non-magnifying NBI in the water injection group and the gas injection group were 97.0%(128/132),81.8%(36/44),94.3%(166/176)and 98.6%(216/219),72.0%(39/54)and 93.4%(255/273),respectively.For novice endoscopists,the sensitivity,specificity and accuracy of NICE typing diagnosis under non-magnifying NBI in water injection group and gas injection group were 51.5%(68/132),72.7%(32/44),56.8%(100/176),46.1%(101/219),63.0%(34/54),49.5%(135/273),respectively.The agreement of highly experienced endoscopists and novice endoscopists was low in two groups respectively(κ=0.199,0.076).Conclusions:Between whatever water or gas injection colonoscopy,NICE typing under non-magnifying NBI is effective in distinguishing neoplastic from non-neoplastic small colorectal polyps for highly experienced endoscopists,which has high diagnostic value and is instructive for treatment strategy of small colorectal polyps in ambulatory ward.