方法

将入组的结肠镜检查的患者按1:1随机分为两组。白光模式下进镜至盲肠，分别以LCI或WLI进行第一次右半结肠观察。退镜观察至肝曲，以LCI模式再次进镜至盲肠，并使用WLI模式对先前应用LCI模式进行第一次观察的患者进行第二次右半结肠观察 （LCI-WLI组），WLI-LCI组则反之。主要评价指标为LCI-WLI组和WLI-LCI组腺瘤漏诊率。

Methods: Consecutive patients undergoing colonoscopy were randomized (1:1) after cecal intubation into right colon inspection at first pass by LCI or by WLI. At the hepatic flexure, the scope was reintroduced to the cecum under LCI and a second right colon inspection was performed under WLI in previously LCI-scoped patients (LCI-WLI group) and vice versa (WLI-LCI group). Lesions detected on first- and second-pass examinations were used to calculate detection and miss rates, respectively. The primary outcome was the right colon adenoma miss rate.

结果

在纳入的600例患者中，142例至少有一个右结肠腺瘤，两组右结肠腺瘤检出率(r-ADR)相似(LCI-WLI组为22.7%，WLI-LCI组为24.7%)。 在息肉分析中，对LCI-WLI组和WLI-LCI组的右结肠进行双重检查，腺瘤漏检率分别为11.8%和30.6% (P < 0.001)。 进展期腺瘤或无蒂锯齿状病变的漏诊率无显著差异。 在患者的分析中，LCI-WLI组的300名患者中有2名(0.7%)在第二次检查中发现了至少一个腺瘤(增加的ADR)，而WLI-LCI组的300名患者中有13名(4.3%)在第二次检查中发现了至少一个腺瘤(P=0.01)。

Results: Of the 600 patients enrolled, 142 had at least one adenoma in the right colon, with similar right colon adenoma detection rates (r-ADR) in the two groups (22.7 % in LCI-WLI and 24.7 % in WLI-LCI). At per-polyp analysis, double inspection of the right colon in the LCI-WLI and WLI-LCI groups resulted in an 11.8 % and 30.6 % adenoma miss rate, respectively (P < 0.001). No significant difference in miss rate was found for advanced adenomas or sessile serrated lesions. At per-patient analysis, at least one adenoma was identified in the second pass only (incremental ADR) in 2 of 300 patients (0.7 %) in the LCI - WLI group and in 13 of 300 patients (4.3 %) in the WLI - LCI group (P = 0.01).