方法

在粪便免疫化学试验(FIT)阳性后，连续接受筛选结肠镜检查的受试者1:1随机分为LCI组和WLI组，均采用高清系统。每个结肠镜检查的进镜和退镜阶段都使用相同的指定光进行。来自7个意大利中心的经验丰富的内镜医生参与了这项研究。按性别、年龄和筛查轮随机分层。主要观察指标为ADR。

Methods: Consecutive subjects undergoing screening colonoscopy after fecal immunochemical test (FIT) positivity were 1:1 randomized to undergo colonoscopy with LCI or WLI, both in high-definition systems. Insertion and withdrawal phases of each colonoscopy were carried out using the same assigned light. Experienced endoscopists from 7 Italian centers participated in the study. Randomization was stratified by gender, age, and screening round. The primary outcome measure was represented by ADR.

结果

在704名符合条件的受试者中，649名(48.9%男性，平均年龄±标准差，60.8±7.3岁)随机接受LCI(326例)或WLI(323例)结肠镜检查。LCI组腺瘤检出率(ADR) (51.8%)高于WLI组(43.7%)(相对风险为1.19; 95%置信区间，1.01-1.40)。 晚期腺瘤和无蒂锯齿状病变患者的比例，LCI组分别为21.2%和8.6%，WLI组分别为18.9%和5.9%(两组比较均无统计学意义)。 多因素分析显示，LCI与ADR、男性性别、年龄增长和充足的肠道准备(波士顿肠道准备量表评分≥6)均独立相关。 在息肉分析中，LCI组和WLI组每次结肠镜检查腺瘤的平均±标准偏差数是相似的，而LCI组近端腺瘤的数量显著更高（ 72±1.2 vs .55±1.07,P = .05） 。

Results: Of 704 eligible subjects, 649 were included (48.9% men, mean age ± standard deviation, 60.8 ± 7.3 years) and randomized to LCI (n = 326) or WLI (n = 323) colonoscopy. The ADR was higher in the LCI group (51.8%) than in the WLI group (43.7%) (relative risk, 1.19; 95% confidence interval, 1.01-1.40). The proportions of patients with advanced adenomas and sessile serrated lesions were, respectively, 21.2% and 8.6% in the LCI arm and 18.9% and 5.9% in the WLI arm (not significant for both comparisons). At multivariate analysis, LCI was independently associated with ADR, along with male gender, increasing age, and adequate (Boston Bowel Preparation Scale score ≥6) bowel preparation. At per-polyp analysis, the mean ± standard deviation number of adenomas per colonoscopy was comparable in the LCI and WLI arms, whereas the corresponding figures for proximal adenomas was significantly higher in the LCI group (.72 ± 1.2 vs .55 ± 1.07, P = .05) .