Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Narrow Band Imaging and White Light Colonoscopy for Detection of Polyps

협대역영상과 백색광원을 이용한 대장내시경의 용종 발견율

  • Han, Seok-Jae (Department of Internal Medicine, Catholic University of Daegu College of Medicine) ;
  • Kim, Eun-Young (Department of Internal Medicine, Catholic University of Daegu College of Medicine) ;
  • Park, Jae-Bum (Department of Internal Medicine, Catholic University of Daegu College of Medicine) ;
  • Cheon, Jong-Woon (Department of Internal Medicine, Catholic University of Daegu College of Medicine) ;
  • Kim, Ka-Young (Department of Internal Medicine, Catholic University of Daegu College of Medicine) ;
  • Shin, Young-Kook (Department of Internal Medicine, Catholic University of Daegu College of Medicine) ;
  • Oh, Jang-Seok (Department of Internal Medicine, Catholic University of Daegu College of Medicine) ;
  • Kim, Byung-Seok (Department of Internal Medicine, Catholic University of Daegu College of Medicine) ;
  • Han, Ji-Min (Department of Internal Medicine, Catholic University of Daegu College of Medicine) ;
  • Jung, Jin-Tae (Department of Internal Medicine, Catholic University of Daegu College of Medicine) ;
  • Kwon, Joong-Goo (Department of Internal Medicine, Catholic University of Daegu College of Medicine) ;
  • Lee, Chang-Hyeong (Department of Internal Medicine, Catholic University of Daegu College of Medicine) ;
  • Kim, Ho-Gak (Department of Internal Medicine, Catholic University of Daegu College of Medicine)
  • 한석재 (대구가톨릭대학교 의과대학 내과학교실) ;
  • 김은영 (대구가톨릭대학교 의과대학 내과학교실) ;
  • 박재범 (대구가톨릭대학교 의과대학 내과학교실) ;
  • 천종운 (대구가톨릭대학교 의과대학 내과학교실) ;
  • 김가영 (대구가톨릭대학교 의과대학 내과학교실) ;
  • 신영국 (대구가톨릭대학교 의과대학 내과학교실) ;
  • 오장석 (대구가톨릭대학교 의과대학 내과학교실) ;
  • 김병석 (대구가톨릭대학교 의과대학 내과학교실) ;
  • 한지민 (대구가톨릭대학교 의과대학 내과학교실) ;
  • 정진태 (대구가톨릭대학교 의과대학 내과학교실) ;
  • 권중구 (대구가톨릭대학교 의과대학 내과학교실) ;
  • 이창형 (대구가톨릭대학교 의과대학 내과학교실) ;
  • 김호각 (대구가톨릭대학교 의과대학 내과학교실)
  • Published : 2011.03.30
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Abstract

Background/Aims: Narrow band imaging (NBI) is a new technique that is expected to improve the detection rate of colorectal polyps, but results have been inconsistent. The aim of this study was to compare the polyp miss rate and the characteristics of missed colorectal polyps using white light (WL) and NBI. Methods: 62 patients were randomized into two groups. In the first group (NBI first, NBIF), a colonoscopic examination of each segment (cecum-ascending, transverse, descending, and rectosigmoid colons) was performed first with NBI followed by a re-examination of the same segment using WL. An opposite sequence was applied for the other group (white light first, WLF). Results: 67 polyps were found in the first examination, and 31 polyps were found on the re-examination, resulting in a polyp miss rate of 31.6%. The polyp miss rate was 39% for WLF and 23% for NBIF (p>0.05). Seventy-four small polyps (<5 mm) were found, and miss rates for NBIF and WLF were 20% and 46%, respectively (p=0.01). The polyp miss rate at the rectosigmoid was 11% for NBIF and 54% for WLF (p=0.01). Conclusions: The polyp miss rate was not significantly different between NBI or WL when a colonoscopy was performed. NBI resulted in a lower polyp miss rate for small (<5 mm) and rectosigmoid polyps than WL.

목적: 협대역 내시경(narrow band imaging, NBI)은 대장 용종 발견율을 향상시킬 것으로 기대되는 새로운 기술이나 관련한 연구 결과들은 일정하지 않다. 저자들은 NBI와 백색광원 내시경(white light, WL)을 이용한 구역별 반복 대장내시경검사를 통하여 두 모드별 용종 간과율의 차이 및 영향인자에 대해 알아보았다. 대상 및 방법: 2009년 5월부터 2009년 8월까지 대구가톨릭 대학병원 소화기내과를 방문한 환자 중 경미한 복통 등의 증상으로 대장내시경검사를 받기 원하는 환자를 대상으로 전향적으로 연구하였다. 대상자는 무작위로 2개군으로 나누어 WL 선행군은 WL로 관찰 후 다시 NBI로 관찰하였고, NBI 선행군은 반대로 먼저 NBI로 관찰 후 WL로 한번 더 관찰하였다. 용종의 크기, 위치, 조직 특성 그리고 장 정결도에 따른 용종의 간과율에 대해 비교 분석하였다. 결과: 전체 대상 환자는 62명으로 WL 선행군은 32명, NBI 선행군은 30명이었다. 용종은 37명의 환자에서 98개가 발견되었다. 첫 번째 관찰에서 67개의 용종이 발견되었고 두 번째 관찰에서 31개가 추가로 발견되어 전체 용종 간과율은 31.6%였다. 두 군의 용종 간과율은 NBI 선행군 23%, WL 선행군 39%로 NBI 선행군에서 낮은 경향을 보였으나, 통계적으로 유의하지는 않았다(p>0.05). 5 mm 이하의 작은 용종은 74개가 발견되었으며 간과율은 NBI 선행군 20%, WL 선행군 46%로 NBI 선행군이 통계적으로 유의하게 낮았다(p=0.01). 위치에 따른 용종 간과율은 구불결장-직장에서 NBI 선행군 11%, WL 선행군 54%로 NBI 선행군이 통계적으로 유의하게 낮았다(p=0.01). 결론: NBI와 백색광원 내시경(WL)을 이용한 구역별 반복 대장내시경검사에서 용종 간과율은 두 군에서 통계적으로 유의한 차이를 보이지 않았으나 NBI는 5 mm 미만의 작은 용종 및 구불결장-직장에 위치한 용종의 발견에 있어서 WL보다 더 유용하였다.

Keywords

References

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