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Master's Dissertation
DOI
https://doi.org/10.11606/D.5.2013.tde-08082013-151359
Document
Author
Full name
Flávio de Castro Feitosa
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2013
Supervisor
Committee
Damião, Aderson Omar Mourão Cintra (President)
Ribeiro Júnior, Ulysses
Vieira, Andrea
Title in Portuguese
Comparação entre a colonoscopia com cromoscopia e com o NBI para detecção de displasia e neoplasias colônicas em pacientes com doença inflamatória intestinal de longa data: estudo randomizado e controlado
Keywords in Portuguese
Doença de Crohn
Doenças inflamatórias intestinais
Endoscopia gastrointestinal/métodos
Ensaio clínico controlado randomizado
Neoplasias colorretais
Retocolite ulcerativa
Abstract in Portuguese
Introdução: Pacientes com doença inflamatória intestinal (DII) tem risco aumentado de desenvolvimento de displasias e neoplasias colônicas, a partir de 8 anos de diagnóstico da doença. O desenvolvimento de técnicas que melhorem a acurácia diagnostica destas displasias tem impacto científico, econômico e na prática clínica. Materiais and Métodos: O NBI (narrow band image) tem sido descrito como um método comparável à cromoscopia para a detecção de diversos tipos de cânceres do trato gastrointestinal superior e do sistema respiratório. Neste estudo, as duas técnicas foram comparadas em pacientes com DII de longa data. Resultados: 34 pacientes foram randomizados (18 para a cromoscopia e 16 para o NBI). 66,7% e 68,8% dos pacientes eram do gênero feminino, com média de idade de 48,5 e 49,6 anos, nos grupos cromoscopia e NBI, respectivamente. 61,1% dos pacientes do grupo cromoscopia e 56,2% do grupo NBI tinham doença de Crohn (DC). Nenhuma destas variáveis alcançou diferença estatísticamente significante na comparação entre os grupos: comportamento da DC, localização da retocolite ulcerativa, presença de atividade inflamatória endoscópica e sintomas no momento do exame. O tempo médio gasto para a realização do exame foi de 45,8 minutos no grupo cromoscopia e de 34,1 minutos no grupo NBI. Sobre a presença de displasias, 22,2% dos pacientes no grupo cromoscopia apresentaram lesões displásicas no exame histológico (todas as biopsias foram direcionadas pela presença de lesões), enquanto que, no grupo NBI, nenhuma lesão displásica foi encontrada (qui-quadrado= 4,477; ∑crítico> 3,841, considerando um erro a de 5%). Foram encontrados três lesões adenomatosas e uma lesão displásica tipo DALM (dysplasia-associated lesion or mass), típica da DII. Quando realizada a correção de Yattes, ara amostras pequenas, foi observado ∑ = 2,180 (∑crítico> 3,841, considerando um erro a de 5%). Conclusões: Esses dados mostram diferença estatística entre as técnicas endoscópicas (NBI e cromoscopia). Eles revelam uma forte tendência estatística de superioridade da cromoscopia, comparada ao NBI.
Title in English
Comparison between colonoscopy with chromoendoscopy and NBI for the detection of colonic neoplasia and dysplasia in patients with inflammatory bowel disease of long standing: a randomized controlled trial
Keywords in English
Colorectal neoplasms
Crohn disease
Endoscopy gastrointestinal/methods
Inflammatory bowel diseases
Proctocolitis
Randomized controlled trial
Abstract in English
Introduction: Patients with inflammatory bowel disease (IBD) are under increased risk of colonic dysplasia and neoplasia, approximately, 8 years after diagnosis. The development of techniques that improve the diagnostic ability to detect those dysplasias has scientific, economic and practical impact. Materials and Methods: The NBI (narrow band image) has been described as a valuable method comparable to chromoendoscopy for the detection of many cancers of the upper digestive and respiratory systems. The two techniques were compared in this study in patients with IBD after at least 8 years from diagnosis. Results: 34 patients were randomized (18 for chromoendoscopy and 16 for NBI). 66.7% and 68.8% were female, mean age of 48.5 and 49.6 years, in chromoendoscopy and NBI groups, respectively. The mean disease duration was 14.7 (DP 6.5 years 2) and 15.6 years (DP 9.0 years 2) for chromoendoscopy and NBI, respectively. 61.1% of patients in the chromoendoscopy group and 56.2% in the NBI had Crohn's disease (CD). None of those epidemiological data, extension and behavior of CD and Ulcerative Colitis, use of medications, endoscopic grade of disease activity and symptoms at the time of the exam disclosed statistical significance. The average time of examination was 45.8 minutes for the chromoendoscopy group, versus 34.1 minutes for the NBI group. Regarding the presence of dysplasia, 22,2% of patients in the chromoendoscopy group showed some dysplastic lesions on histological examination (all biopsies directed to mucosal lesions), while no patients in the NBI group had such lesions (chi-square = 4.477; ∑critical> 3.841, considering an error of 5%). We found three adenomas and one dysplastic lesions of the type DALM (dysplasia-associated lesion or mass), typical of IBD. When we look at correcting by means of the Yates correction test for small samples, we observed ∑ = 2,180 (∑critical > 3.841, considering an error of 5%). Conclusion: Those data have shown statistical difference between the endoscopic techniques (NBI and chromoendoscopy). They revealed a strong statistical tendency of superiority of chromoendoscopy compared to NBI.
 
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Publishing Date
2013-08-09
 
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