Abstract：
Blue-light imaging (BLI) is a new image-enhanced endoscopy with a wavelength filter similar to narrow-band imaging (NBI). We compared the 2 with white-light imaging (WLI) on proximal colonic lesion detection and miss rates.
In this 3-arm prospective randomized study with tandem examination of the proximal colon, we enrolled patients aged ≥40 years. Eligible patients were randomized in 1:1:1 ratio to receive BLI, NBI, or WLI during the first withdrawal from the proximal colon. The second withdrawal was performed using WLI in all patients. Primary outcomes were proximal polyp (pPDRs) and adenoma (pADRs) detection rates. Secondary outcomes were miss rates of proximal lesions found on tandem examination.
Of 901 patients included (mean age, 64.7 years; 52.9% men), 48.1% underwent colonoscopy for screening or surveillance. The corresponding pPDRs of the BLI, NBI, and WLI groups were 45.8%, 41.6, and 36.6%, whereas the corresponding pADRs were 36.6%, 33.8%, and 28.3%. There was a significant difference in pPDR and pADR between BLI and WLI groups (difference, 9.2% [95% confidence interval {CI}, 3.3-16.9] and 8.3% [95% CI, 2.7-15.9]) and between NBI and WLI groups (difference, 5.0% [95% CI, 1.4-12.9] and 5.6% [95% CI, 2.1-13.3]). Proximal adenoma miss rates were significantly lower with BLI (19.4%) than with WLI (27.4%; difference, -8.0%; 95% CI, -15.8 to -.1) but not between NBI (27.2%) and WLI.
Both BLI and NBI were superior to WLI on detecting proximal colonic lesions, but only BLI had lower proximal adenoma miss rates than WLI. (Clinical trial registration number: NCT03696992.).
In this 3-arm prospective randomized study with tandem examination of the proximal colon, we enrolled patients aged ≥40 years. Eligible patients were randomized in 1:1:1 ratio to receive BLI, NBI, or WLI during the first withdrawal from the proximal colon. The second withdrawal was performed using WLI in all patients. Primary outcomes were proximal polyp (pPDRs) and adenoma (pADRs) detection rates. Secondary outcomes were miss rates of proximal lesions found on tandem examination.
Of 901 patients included (mean age, 64.7 years; 52.9% men), 48.1% underwent colonoscopy for screening or surveillance. The corresponding pPDRs of the BLI, NBI, and WLI groups were 45.8%, 41.6, and 36.6%, whereas the corresponding pADRs were 36.6%, 33.8%, and 28.3%. There was a significant difference in pPDR and pADR between BLI and WLI groups (difference, 9.2% [95% confidence interval {CI}, 3.3-16.9] and 8.3% [95% CI, 2.7-15.9]) and between NBI and WLI groups (difference, 5.0% [95% CI, 1.4-12.9] and 5.6% [95% CI, 2.1-13.3]). Proximal adenoma miss rates were significantly lower with BLI (19.4%) than with WLI (27.4%; difference, -8.0%; 95% CI, -15.8 to -.1) but not between NBI (27.2%) and WLI.
Both BLI and NBI were superior to WLI on detecting proximal colonic lesions, but only BLI had lower proximal adenoma miss rates than WLI. (Clinical trial registration number: NCT03696992.).
摘要：
目的：蓝光成像（BLI）是一种新型的图像增强内窥镜，其波长滤波器类似于窄带成像（NBI）。我们将两者与白光成像（WLE）在近端结肠病变检测和漏检率方面进行了比较。
方法：这是一项对近端结肠进行串联检查的三臂前瞻性随机研究。我们招募了40岁或以上的患者。符合条件的患者以1:1:1的比例随机接受BLI，NBI或WLE在第一次撤回近端结肠期间。所有患者均在WLE下进行第二次停药。主要结果是近端息肉（pPDR）和腺瘤（pADR）的检出率。次要结果是串联检查发现的近端病变的错失率。
结果：包含901例患者（平均年龄64.7岁，52.9％的男性）和48.1％的人接受了结肠镜检查以进行筛查或监测。相应的BLI的PDR，NBI和WLE组为45.8%,41.6和36.6%，而相应的pADR为36.6%，33.8%和28.3%。BLI和WLE之间的pPDR和pADR存在显着差异（差异：9.2％，95%CI3.3-16.9%；8.3%，95CI2.7-15.9%）或NBI和WLE之间（差异：5.0%，95CI1.4-12.9%；5.6%，95CI2.1-13.3%）。BLI的近端腺瘤漏检率(19.4%)明显低于WLE(27.4%;差异-8.0%,95CI-15.8%至-0.1%），但不在NBI（27.2%）和WLE之间。
结论：BLI和NBI在发现结肠近端病变方面均优于WLE，但只有BLI的近端腺瘤漏检率低于WLE。
方法：这是一项对近端结肠进行串联检查的三臂前瞻性随机研究。我们招募了40岁或以上的患者。符合条件的患者以1:1:1的比例随机接受BLI，NBI或WLE在第一次撤回近端结肠期间。所有患者均在WLE下进行第二次停药。主要结果是近端息肉（pPDR）和腺瘤（pADR）的检出率。次要结果是串联检查发现的近端病变的错失率。
结果：包含901例患者（平均年龄64.7岁，52.9％的男性）和48.1％的人接受了结肠镜检查以进行筛查或监测。相应的BLI的PDR，NBI和WLE组为45.8%,41.6和36.6%，而相应的pADR为36.6%，33.8%和28.3%。BLI和WLE之间的pPDR和pADR存在显着差异（差异：9.2％，95%CI3.3-16.9%；8.3%，95CI2.7-15.9%）或NBI和WLE之间（差异：5.0%，95CI1.4-12.9%；5.6%，95CI2.1-13.3%）。BLI的近端腺瘤漏检率(19.4%)明显低于WLE(27.4%;差异-8.0%,95CI-15.8%至-0.1%），但不在NBI（27.2%）和WLE之间。
结论：BLI和NBI在发现结肠近端病变方面均优于WLE，但只有BLI的近端腺瘤漏检率低于WLE。
