Background and Aims

Colorectal flat (nonpolypoid) lesions can be overlooked during colonoscopy. This study evaluated the efficacy of updated autofluorescence imaging (AFI) for detecting colorectal flat neoplasms.

Methods

This was a prospective, multicenter, randomized controlled trial in 9 Japanese tertiary institutions. Patients undergoing colonoscopy because of positive fecal immunochemical tests, surveillance after polypectomy, or investigation of minor symptoms were enrolled and randomly assigned to either the white-light imaging (WLI) or the AFI group. Primary outcome measurement was number of flat neoplasms per patient.

Results

From November 2015 to June 2017, 817 patients were enrolled. After excluding 15 patients, 802 were finally analyzed (404, WLI; 398, AFI). Patients’ backgrounds (sex, age, indication of colonoscopy, experience of endoscopists) and quality of colonoscopy (bowel preparation, sedative use, cecal insertion rate, insertion and withdrawal time) were not different between groups. Number of flat neoplasms in each patient was significantly higher in the AFI than in the WLI group (.87 [95% confidence interval [CI], .78-.97] vs .53 [95% CI, .46-.61]), whereas overall and polypoid neoplasm detection was not significantly different between the groups (1.33 [95% CI, 1.22-1.45] vs 1.14 [95% CI, 1.03-1.24], .46 [95% CI, .40-.53] vs .60 [95% CI, .53-.68]). Flat neoplasms were more frequently detected in the right-sided colon with AFI (.61 [95% CI, .54-.70] vs .30 [95% CI, .25-.36]) but not in the left-sided colon and rectum (.26 [95% CI, .21-.32] vs .23 [95% CI, .19-.28]).

Conclusions

Updated AFI improves the detection of flat colorectal neoplasms in the right-sided colon compared with WLI. (Clinical trial registration number: UMIN000019355.)

中文翻译：

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自体荧光成像在扁平肿瘤检测中的功效：多中心随机对照试验（A-FLAT试验）

背景和目标

结肠镜检查可忽略大肠扁平（非息肉状）病变。这项研究评估了更新的自发荧光成像（AFI）在检测结直肠扁平肿瘤中的功效。

方法

这是在9个日本大专院校中进行的前瞻性，多中心，随机对照试验。收集因粪便免疫化学试验阳性，息肉切除术后监测或轻微症状调查而接受结肠镜检查的患者，并将其随机分配至白光成像（WLI）或AFI组。主要结局指标为每位患者的扁平肿瘤数量。

结果

从2015年11月到2017年6月，招募了817例患者。在排除15位患者之后，最终分析了802位患者（404，WLI； 398，AFI）。两组患者的背景（性别，年龄，结肠镜检查的指征，内镜医师的经验）和结肠镜检查的质量（大便准备，镇静剂使用，盲肠插入率，插入和退出时间）没有差异。与WLI组相比，AFI中每例患者的扁平肿瘤数量显着更高（.87 [95％置信区间[CI] ，. 78-.97]与.53 [95％CI，.46-.61] ），而两组间的整体和息肉状肿瘤检测无显着差异（1.33 [95％CI，1.22-1.45]与1.14 [95％CI，1.03-1.24] 、. 46 [95％CI，.40-.53 ] vs.60 [95％CI，.53-.68]。扁平结肠癌在AFI右侧结肠中的检出率更高（.61 [95％CI，.54-.70] vs.

结论

与WLI相比，更新后的AFI改善了右侧结肠扁平结肠直肠肿瘤的检测。（临床试验注册号：UMIN000019355。）