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Endoskopie heute 2011; 24(2): 109-116
DOI: 10.1055/s-0031-1271537
Originalarbeit

© Georg Thieme Verlag KG Stuttgart ˙ New York

NBI versus hochauflösende Endoskopie in der Diagnostik von Neoplasien bei Colitis ulcerosa

Narrow-Band Imaging Versus High-Definition Endoscopy for the Diagnosis of Neoplasia in Ulcerative ColitisF. J. C. van den Broek1 , P. Fockens1 , S. van Eeden2 , P. C. F. Stokkers1 , C. Y. Ponsioen1 , J. B. Reitsma3 , E. Dekker1
  • 1Department of Gastroenterology and Hepatology, Academic Medical Centre Amsterdam, The Netherlands
  • 2Department of Pathology, Academic Medical Centre Amsterdam, The Netherlands
  • 3Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre Amsterdam, The Netherlands
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Publication History

Publication Date:
18 July 2011 (online)

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Zusammenfassung

Hintergrund und Studienziele: Welche koloskopische Technik für die Diagnostik von Neoplasien bei Patienten mit Colitis ulcerosa am sensitivsten ist, darüber bestehen unterschiedliche Ansichten. Wir verglichen das Narrow-Band-Imaging (NBI) einer neuen Generation mit hochauflösender (high-definition) Endoskopie (HDE) bei der Detektion von Neoplasien und evaluierten NBI bei der Unterscheidung zwischen neoplastischer und nicht-neoplastischer Mukosa. Patienten und Methoden: In einer randomisier­ten Crossvover-Studie wurden Colitis-ulcerosa-Patienten sowohl mit NBI als auch HDE-Koloskopie unter­sucht, wobei zumindest 3 Wochen zwischen den beiden Prozeduren lagen, die von unter­schiedlichen Endoskopikern durchgeführt wurden. Die Läsionen, die bei der Erstunter­suchung detektiert wurden, verblieben in situ, um sie bei der 2. Untersuchung ebenfalls auffinden zu können. Zielkriterien waren 1. die Detektion von Neoplasien, 2. die diagnostische Genauigkeit von NBI bei der Unterscheidung zwischen neoplastischer und nicht-neoplastischer Mukosa anhand der KUDO-Klassifikation und der vaskulären Gefäßintensität (VPI). Ergebnisse: 25 Patienten wurden zuerst zur HDE randomisiert, 26 primär zu NBI. Von 16 neoplas­tischen Läsionen wurden 11 (69 %) durch HDE und 13 (81 %) durch NBI detektiert (p = 0,727). Von 11 Patienten mit Neoplasien wurden 9 (82 %) durch HDE und 8 (73 %) durch NBI detektiert (p = 1,0). Für die KUDO-Klassifikation betrugen Sensitivität 76 %, Spezifität 66 % und die Accuracy 67 %. Für die VPI betrugen die Sensitivität 80 %, die Sepzifität 72 % und die Accuracy 73 %. Schlussfolgerung: NBI verbessert im Vergleich zur HDE bei Patienten mit Colitis ulcerosa die Detek­tion der Neoplasien nicht. NBI lieferte bei der Unterscheidung zwischen neoplastischer und nicht-neoplastischer Mukosa unbefriedigende Resultate. 

Abstract

Background and study aims: Controversy exists about which colonoscopic technique is most sensitive for the diagnosis of neoplasia in patients with ulcerative colitis. We compared new-generation narrow-band imaging (NBI) to high-definition endoscopy (HDE) for the detection of neoplasia and evaluated NBI for the differentiation of neoplastic from non-neoplastic mucosa. Patients and methods: Randomized crossover trial in which patients with ulcerative colitis under­went both NBI and HDE colonoscopy in random order with at least 3 weeks between the two procedures, which were performed by different endoscopists. Lesions detected during the first examination were left in situ in order to enable detection during the second examination as well. Main outcome measures were (1) neoplasia detection, and (2) diagnostic accuracy of NBI for ­differentiating neoplastic from non-neoplastic mucosa by using the Kudo classification and vascular pattern intensity (VPI). Results: Twenty-five patients were randomized to undergo HDE first and 23 to undergo NBI first. Of 16 neoplastic lesions, 11 (69 %) were detected by HDE and 13 (81 %) by NBI (P = 0.727). Of 11 patients with neoplasia, 9 (82 %) were diagnosed by HDE and 8 (73 %) by NBI (P = 1.0). The sensitivity, specificity, and accuracy of the Kudo classification were 76 %, 66 % and 67 %. Corresponding figures for VPI were 80 %, 72 % and 73 %. Conclusion: NBI does not improve the detection of neoplasia in patients with ulcerative colitis compared to HDE. In addition, NBI proves unsatisfactory for differentiating neoplastic from non-neoplastic mucosa.

Schlüsselwörter

NBI - hochauflösende Endoskopie - Colitis ulcerosa - Neoplasien

Key words

NBI - high-definition endoscopy - ulcerative colitis - neoplasia

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