聚乙二醇联合低剂量硫酸镁在2型糖尿病患者结肠镜肠道准备中的应用价值

目的:探讨聚乙二醇联合低剂量硫酸镁在2型糖尿病患者结肠镜肠道准备中的应用价值。方法:前瞻性纳入120例2型糖尿病结肠镜肠道准备患者,随机分为常规组和联合组两组,每组60例。常规组采用聚乙二醇3 L分割剂量方案,联合组在常规组方案基础上再口服50 ml 50%硫酸镁溶液。两组患者健康宣教和饮食调整方法相同。由一名单盲状态的内镜医师采用波士顿肠道准备评分量表（BBPS）评估两组患者肠道清洁质量,包括全结肠BBPS得分、肠道准备充分（BBPS≥6分,且各段结肠评分均≥2分）率、各段结肠（升结肠-盲肠段、横结肠-降结肠段、直肠-乙状结肠段）BBPS得分和BBPS＜2分的比例,使用自制调查问卷评估两组患者肠道准备的耐受性和不良反应（恶心/呕吐、腹胀、腹痛、直肠烧灼感）。结果:联合组全结肠BBPS得分(7.7±1.3 比7.1±1.5)、肠道准备充分率(90%比75%)显著高于常规组(P＜0.05)。联合组升结肠-盲肠段(2.4±0.4 比2.1±0.5)、横结肠-降结肠段(2.7±0.5 比2.5±0.5)BBPS得分显著高于常规组(P＜0.05),且上述2段结肠BBPS＜2分患者比例(1.7% 比11.7%;0比8.3%)显著低于常规组(P＜0.05),两组直肠-乙状结肠段BBPS得分和BBPS＜2分患者比例差异未见统计学意义(P＞0.05)。两组肠道准备不良反应和耐受性差异未见统计学意义(P＞0.05)。结论:聚乙二醇联合低剂量硫酸镁可以提高2型糖尿病患者结肠镜肠道准备质量,且并不增加不良反应发生风险。     

智能手机多功能教育平台指导中青年人结肠镜检查肠道准备

目的:探讨借助智能手机建立多功能教育平台对中青年人结肠镜检查肠道准备质量的影响。方法:前瞻性纳入2016年7月至2017年6月我院门诊拟行结肠镜检查的中青年患者120例，随机分成手机组和常规组，每组各60例。手机组在预约肠镜时给予口头宣教，后续通过智能手机多功能宣教平台进行:微信公众号多媒体教育，推送文字、图片和视频形式的肠道准备知识网页；微信公众号咨询指导，实时解答患者肠道准备过程中遇到的具体问题；备忘录闹钟提醒服务，对饮食调整和肠道清洁剂服用的各个关键节点分别进行定时提醒。常规组在预约肠镜时给予口头宣教，并发放纸质说明材料由患者带回参阅。观察两组肠道准备方案的执行情况，不良反应发生情况，教育指导满意度，波士顿肠道准备量表（BBPS）评分情况，肠道准备临床失败率（BBPS＜6分），平均进镜时间。结果:与常规组比较，手机组饮食调整(22.5±2.1 vs 18.7±4.5，t=5.927，P<0.001)和缓泻剂服用(18.2±2.2 vs 15.4±3.3，t=5.469，P<0.001)的遵从执行程度提高，呕吐(8.3% vs 23.3%，χ2=5.065，P=0.024)和腹胀(5.0% vs 16.7%，χ2=4.227，P=0.040)不良反应发生率减少，教育指导满意度提高(8.7±1.2 vs 7.9±1.7，t=2.978，P=0.004)，BBPS评分改善(7.4±1.2 vs 6.6±1.5，t=3.226，P=0.002)，肠道准备临床失败率降低(6.7% vs 21.7%，χ2=5.551，P=0.018)，进镜时间缩短(9.1±3.3 vs 10.6±4.2， t=2.175，P=0.032)，差异均具有统计学意义（P<0.05或P<0.01）。结论:借助智能手机建立多功能宣教平台，提高了中青年人结肠镜检查肠道准备的依从性、安全性和满意度，改善了肠道准备质量，有助于结肠镜检查的成功顺利操作。     

聚乙二醇电解质散剂联合低剂量硫酸镁与西甲硅油在结肠镜检查前肠道准备中的应用

目的：探讨聚乙二醇电解质散剂（PEG）中加入低剂量硫酸镁和西甲硅油在结肠镜检查前肠道准备中的应用和观察。方法：150例行结肠镜检查的患者,按不同肠道准备方法随机分为三组：A组：PEG;B组：PEG＋低剂量硫酸镁;C组：PEG＋低剂量硫酸镁＋西甲硅油,每组50例。比较不同方法的有效性、安全性及耐受性。结果：所有患者均完成肠道准备和全结肠镜检查。肠道清洁度比较,C组、B组均优于A组,差异有统计学意义（96％vs 92％vs 72％,χ2＝6．78,χ2＝10．71,均P＜0．05）。肠道内气泡产生率比较,C组优于B组和A组,差异有统计学意义（χ2＝6．35,χ2＝4．33,均P＜0．05）。三种肠道准备方法的不良反应、药物耐受情况差异均无统计学意义（P＞0．05）。结论：聚乙二醇电解质散剂联合低剂量硫酸镁和西甲硅油用于结肠镜检查前的肠道准备,有效性较高,安全性和耐受性值得进一步探讨。     

手机微信短视频教育指导方式对结肠镜检查患者肠道准备清洁质量的影响

目的:观察手机微信短视频的教育指导方式对结肠镜检查患者肠道准备清洁质量的影响.方法:前瞻性纳入我院门诊拟行结肠镜检查患者100例,随机分为常规组和实验组,每组50例.常规组采用常规的口头和书面形式告知结肠镜检查注意事项和肠道准备方法,实验组在常规口头和书面形式告知的基础上通过微信发送教育指导短视频.两组患者均采用相同的聚乙二醇电解质散剂4 L分次标准方案进行肠道准备.记录两组患者肠道准备过程中的不良反应和耐受性,结肠镜检查过程中采用波士顿评分法评估两组患者肠道准备清洁质量,计算两组患者肠道准备充分的百分比.结果:与常规组比较,实验组患者不良反应发生率显著降低(10.0% vs 26.0%,P=0.037),患者耐受性显著增强(3.8±1.2 vs 4.5±1.6,P=0.015),结肠镜下肠道清洁质量波士顿评分显著提高(6.8±1.5 vs 4.7±2.1,P=0.000),肠道准备充分率显著提高(76% vs 52%,P=0.012),差异均具有统计学意义(P<0.05).结论:常规口头和书面形式基础上联合手机微信短视频对结肠镜检查患者肠道准备进行教育指导,有助于增强患者对肠道准备的理解和遵循能力,进而提高安全性、耐受性和肠道清洁质量.     

彩色图文健康教育对老年人结肠镜检查前肠道准备的效果观察

目的： 对比彩色图文健康教育与文字说明教育对老年人结肠检查前肠道准备效果的影响。方法：将148例接受结肠镜检查且符合纳入和排除标准的老年人根据给予健康教育方式的不同分为观察组（口头讲解与彩页图文书面指导）和对照组（口头讲解与文字说明指导）。检查当日均服用聚乙二醇电解质散进行肠道准备,二甲硅油散5g口服袪泡。观察两组间患者依从性、肠道清洁情况,患者不良反应等指标。结果:饮食及药物依从性在观察组（饮食:80.82%,服药：76.71%）显著优于对照组（饮食：42.67%,服药：41.33%）（P<0.05）;肠道清洁效果在观察组显著优于对照组（P<0.05）;患者不良反应发生率观察组(34.25%)与对照组(29.33%)差异无统计学意义（P>0.05）。结论:口头讲解与彩页图文书面指导相结合的健康教育方式能提高老年人在结肠镜检查前服药的依从性,明显提高肠道清洁效果。     

结肠镜在大肠癌术前术中的应用

目的：探讨结肠镜及时发现多原发癌的意义。方法：1987年1月至1995年12月，589例大肠癌患者，术前常规行结肠镜全结肠检查，其中241例（40．8％）行全结肠检查。另348例（59．2％）因病灶堵塞无法行全结肠检查，其中128例术前结肠镜诊断与钡灌肠X线检查有疑问而行术中结肠镜检查。220例术后1～18个月内无症状结肠镜行全结肠随访检查。结果：241例术前行全结肠检查者，发现同时第二原发癌10例（4．1％），腺瘤早期癌变3例（1．2％），腺瘤49例（20．3％）。128例行术中结肠镜检查，发现2例（1．6％）三处同时原发癌，同时第二原发癌11例（8．5％），同时存在腺瘤31例（24．2％）。结论：术前不能行全结肠检查者．术中的结肠镜行全结肠检查能及时发现和彻底治疗同时多个原发病灶。     

粪便隐血试验与SDC2基因甲基化检测在结直肠癌筛查中的效果评价

摘 要：［目的］ 比较粪便SDC2基因甲基化检测与粪便隐血试验用于人群结直肠癌筛查效果,为今后开展结直肠癌筛查技术及方案优化提供科学依据。［方法］ 以海宁市结直肠癌早诊早治筛查为平台,于2021年5月采用整群抽样方法抽取海宁市袁花镇3 000名40～74岁人群为研究对象,将SDC2基因甲基化检测纳入现有筛查路径,初筛包括结直肠癌风险评估、粪便隐血试验和SDC2基因甲基化检测,其中任一项阳性动员电子结肠镜检查,以结肠镜+病理结果为金标准判定筛查结果。［结果］ 共有2 664名对象完成结直肠癌风险评估并按要求同时送检了两份大便样品,其中男性1 303名,女性1 361名。单项粪便SDC2基因甲基化阳性为232例(8.71％),阳性者中116例(50.00％)完成肠镜检查;单项粪便隐血试验阳性为243例(9.12％),阳性者中126例（51.85%）完成结肠镜检查;粪便隐血试验和SDC2基因甲基化检测双阳性51例(Kappa=0.077,P=0.614),双阳性者中28例（54.90%）完成结肠镜检查,三组差异无统计学意义（χ2=0.452, P=0.798）。在单阳性组中,粪便隐血检测的肠道病变检出率50.79%（64/126）,低于粪便SDC2基因甲基化检测的肠道病变检出率51.72%（60/116）,其中粪便SDC2基因甲基化检测的进展期肿瘤检出率12.93%（15/116）,高于粪便隐血试验的进展期肿瘤检出率（8.73%,11/116）（P<0.001）。在双阳性组中,粪便隐血试验联合粪便SDC2基因甲基化检测的肠道病变检出率53.57%（15/28）,其中进展期肿瘤检出率25.00%(7/28),高于单阳性组,但差异无统计学意义（χ2=6.324, P=0.388）。［结论］ 粪便SDC2基因甲基化检测对进展期肿瘤病变检出率高于粪便隐血试验,粪便隐血试验联合SDC2基因甲基化检测有助于提高肠道病变检出率。     

胆汁槟榔维B1胶囊联合复方聚乙二醇电解质散在肠镜检查前的肠道准 备效果观察

目的:探讨胆汁槟榔维B1胶囊联合复方聚乙二醇电解质散在电子肠镜检查前肠道准备中的应用效果。方法:选取2017年1月至2017年12月来我院行电子肠镜检查的180例病人为研究对象,并随机等分为A、B、C三组,A组病人于肠镜检查前6 h口服3盒复方聚乙二醇电解质散;B组病人于肠镜检查前1 d口服胆汁槟榔维B1胶囊;C组患者在检查前1 d口服胆汁槟榔维B1胶囊,并于肠镜检查前6 h口服3盒复方聚乙二醇电解质散。比较三组病人的排便次数、肠道清洁效果、肠道清洁范围、气泡量及不良反应发生情况。结果:C组病人肠道清洁效果、肠道清洁范围、气泡产生量显著优于A、B组,差异具有统计学意义（P<0.05）,肠道清洁效果与气泡产生量A组与B组差异无统计学意义（P>0.05）;排便次数B、C组少于A组（P<0.05）,且B组少于C组,差异有统计学意义（P<0.05）;不良反应发生情况B组低于A、C组（P<0.05）,A组与C组差异无统计学意义（P>0.05）。结论:胆汁槟榔维B1胶囊联合复方聚乙二醇电解质散行肠道准备可明显提高肠道清洁效果、肠道清洁范围、降低气泡产生量,并且不良反应发生率不高于单独使用复方聚乙二醇电解质散,能够取得更加满意的肠道准备效果,可在肠镜检查前肠道准备中广泛推广。     

不同筛查方案结直肠癌筛查随机对照试验基线结果分析

摘 要：［目的］ 分析结肠镜、粪便隐血试验（FIT）及风险评估筛查方案的人群结直肠癌筛查参与率和筛查效果。［方法］ 2018年5月至2019年5月,在安徽省合肥市招募50～74岁且符合研究要求的受试者,将其随机分配到3个筛查组（按1∶2∶2的比例）：结肠镜组、FIT组、风险评估组。所有受试者进行风险调查和评估,结肠镜组进行结肠镜检查,FIT组进行FIT检测,阳性者行结肠镜检查,风险评估组评估为高危者进行结肠镜检查,低危者进行FIT检测。计算不同筛查方案的参与率、检出率和阳性预测值。［结果］ 共计招募3 821名受试者,结肠镜组、FIT组、风险评估组的参与率分别是45.3%（347/766）、96.0%（1 470/1 532）、86.0%(1 310/1 523);结肠镜检查参与率分析显示,FIT组阳性人群参与率最高为80.6%,结肠镜组最低为45.3%,差异有统计学意义（P＜0.05）;三组筛查方法在进展期肿瘤检出率方面,差异无统计学意义（P＞0.05）。FIT组阳性对于进展期腺瘤阳性预测值最高（P＜0.05）。在筛查中所需结肠镜检查负荷指标上,每检出1例进展期肿瘤所需要的结肠镜检查数,结肠镜组为20例,FIT组为10例,风险评估组为19例。［结论］ FIT组及风险评估组显示出较高的参与率,在人群筛查中所需结肠镜检查的负荷数量方面,FIT法展示了较好的筛查效率。     

日本消化道癌普查总会有关大肠癌的信息

1．高龄者大肠癌的普查问题在过去4年间大肠内镜检查合计65皿人中70岁以上者675人。原则上采用…小小小则办毗电解质经回肠道洗净液，全结肠镜检查（TCS）并进行ECG检测。现对刀岁以上者ICS的特点和问题进行分析。结果高龄者大肠内镜检查占10．4％；盲肠到达率88％；内镇检查时出现循环异常者19．17％；在插入中止的病例中有16％系由于血压低下和心电图改变；内镜检查所见率77．8％、癌发现率对．0％（早期癌兀．8％、进展期癌20．2％）；进展期癌以右半结肠最多40．0％；高龄者多发性大肠癌为28．l％，与小于69岁者（7．4％）相比较高…     

Quality Colorectal Cancer Screening: Endoscopic Performance Measures and Beyond

Purpose of Review

The rationale behind and implementation of quality measures around colonoscopy for colorectal (CRC) screening are important topics for endoscopists to understand to deliver exemplary care with the goal of decreasing the incidence of this disease. This article will evaluate recent data on this subject and summarize pertinent findings in the growing field of quality improvement research surrounding colonoscopy for CRC screening.

Recent Findings

Both pre- and intra-procedural metrics have been studied across a variety of practice models and patient populations. Contemporary metrics include adequate bowel preparation, cecal intubation rate, adenoma detection rate, polypectomy rate, proximal serrated polyp detection rate, withdrawal time, and patient satisfaction.

Summary

Multiple quality metrics have been formally evaluated regarding colonoscopy, and others have recently been proposed. Additional validation is necessary to determine which quality metrics serve as practical and implementable to improve endoscopic performance and overall delivery of care.

     

Bristol分型在提高结肠镜检查结肠癌发现率中的作用研究

目的 探讨Bristol粪便分型(BSFS)在提高结肠镜检查结肠癌发现率中的作用.方法 根据BSFS对拟行结肠镜检查的640例患者进行分组,Bristol 1、2型的214例患者为A组,Bristol 3、4型的213例患者为B组,Bristol 5～7型的213例患者为C组.A组采用聚乙二醇电解质4000散+莫沙比利方案准备肠道,B组采用标准聚乙二醇电解质4000散方案,C组采用减量聚乙二醇电解质4000散方案.肠道准备质量由内镜操作医师术中观察肠道清洁程度,同时评估回盲部到达率、平均退镜时间、结肠癌的发现率、不良反应.结果 A组肠道清洁程度好的比例为88.8％(190/214),B组为91.1％(194/213),C组为91.1％(194/213),组间比较,差异无统计学意义(P﹥0.05).A组、B组和C组回盲部到达率分别为93.9％、95.8％和96.7％,差异无统计学意义(P﹥0.05).平均退镜时间3组比较,差异有统计学意义(P﹤0.01);其中B组和C组明显短于A组,差异有统计学意义(P﹤0.01);B组与C组比较,差异无统计学意义(P﹥0.05).结肠癌发现率B组和C组明显高于A组,差异有统计学意义(P﹤0.01);B组与C组比较,差异无统计学意义(P﹥0.05).3组患者不良反应发生率比较,差异无统计学意义(P﹥0.05).结论 BSFS可以有效提高结肠镜检查结肠癌的发现率,值得临床推广.     

A prospective study of bowel preparation for colonoscopy with polyethylene glycol-electrolyte solution versus sodium phosphate in Lynch syndrome: a randomized trial

Lynch gene carriers undergo regular surveillance colonoscopies. Polyethylene glycol-electrolyte solution (PEG) is routinely prescribed for bowel cleansing, but often poorly tolerated by patients. Sodium phosphate (NaP) may be an alternative. Prospective and random comparison of bowel preparation with PEG and NaP on colon cleansing and patients’ acceptance. Patients, who previously underwent a colonoscopy, were invited to participate and randomly assigned to either PEG or NaP. They were asked to fill in a questionnaire about preparation tolerability and future preferences. The endoscopist filled out a report about the quality of colon cleansing. 125 Patients were included in the study. Nine (7%) were excluded because of missing data. The remaining 116 patients (53 PEG and 63 NaP) were included in the analysis. Baseline characteristics did not differ between groups. Before colonoscopy 20 (38%) patients using PEG experienced the preparation almost intolerable, in contrast to 7(11%) of those using NaP (P?=?0.001). Eleven patients in the PEG group and 48 in the NaP group would prefer NaP in the future. The colonoscopy was poorly tolerated in 17% of the individuals in both groups (P?=?0.963). The endoscopist observed a more than 75% clean colon in 83% of patients on PEG and in 71% of patients on NaP (P?=?0.076), however the coecum (P?=?0.025) and ascending colon was cleaner after PEG. Lynch patients tolerated NaP better and preferred this formula for future bowel preparation. Colon cleansing was suboptimal with both treatments with a tendency towards a cleaner proximal colon with PEG.     

Is blinding the endoscopists to bowel preparations in randomized-controlled trials a reality?

BACKGROUND: A number of studies compared the quality, efficacy and tolerability of oral sodium phosphate (NaP) and polyethylene glycol (PEG)-based solutions in preparation for colonoscopy. The primary aim of this study was to explore whether endoscopists can be effectively blinded to the type of bowel preparation. METHODS: We recruited 3 experienced endoscopists and 57 outpatients (18-65 years old) undergoing colonoscopy. We randomized eligible patients to receive one of the two bowel preparations. Endoscopists who performed the tests were blinded to the type of preparation, and made their best judgment on the type and quality of the bowel preparation. RESULTS: Forty-five patients completed the study. The overall correct estimation of the type of bowel preparation was 60.0% (95% CI; 45.5%, 73.0%). The cleansing quality did not differ between the two preparations. Patients found oral NaP solution much easier to take (81.8% versus 36.4%; P = 0.005) and the PEG-based group tended to have more nausea or vomiting. 47.6% of patients in the PEG group indicated they would prefer to try another bowel preparation in the future compared to 4.5% in the oral NaP group (P = 0.002). We stopped the study after an interim analysis indicating that more than 600 patients would be required to detect statistically significant differences in the primary aim. CONCLUSION: Our findings suggest that blinding of endoscopists in clinical trials comparing oral NaP to PEG had a relatively low likelihood of bias. The study also suggests that oral NaP is easier to take and more tolerable than PEG without impairing cleansing quality.     

Evaluation of a test for abnormal rectal mucus for early detection of colon cancer.

This report describes the evaluation of a chemical test for T-antigen in rectal mucus as a screening test for colon cancer. The test, called the Mucus Strip Test, detects the disaccharide residue sialic acid-free beta-D-Gal(1-->3)-D-GalNAc or T-antigen, which accumulates in mucus from malignant cells and colonic mucosa adjacent to cancer but not in normal mucosa. Participants were an unselected case series of 660 persons undergoing colonoscopy, excluding those with ulcerative colitis, polyposis, Crohn's disease, or nonspecific inflammatory bowel disease. In the first study (n = 608) rectal mucus was collected after preparation of the bowel for colonoscopy; in the second study (n = 52) a modified protocol was used to collect mucus approximately 2 weeks before colonoscopy and again following preparation for the procedure. Mucus Strip Test results were compared to the diagnosis received after colonoscopy, which was classified as cancer, adenomatous polyp(s), and others (normal). Analyses were also stratified by previous history of large intestinal disease, classified as previous cancer; previous diagnosis of adenomatous polyp(s); or others. In the first study, T-antigen was detected in approximately 30% of mucus samples, and test results were independent of both diagnosis at colonoscopy and previous medical history. In the second study, T-antigen was detected in 85% of samples collected before and 96% of samples collected after preparation for colonoscopy, but test results were again independent of diagnosis and medical history.(ABSTRACT TRUNCATED AT 250 WORDS)     

Guidelines for an Optimum Screening Colonoscopy

Effective colonoscopy requires a high rate of excellent and good bowel preparations, which can be achieved by split dose or same day dosing. Cecal intubation rates in screening patients should exceed 95%, and experts frequently achieve 99% or more. Cecal intubation should be documented by photographs of the appendiceal orifice and ileocecal valve and notation of landmark visualization. Withdrawal technique must include meticulous inspection of the proximal sides of the folds, clean-up of residual fluid and feces, adequate luminal distension, and adequate withdrawal time. The endoscopist must be familiar with the full spectrum of endoscopic lesions, including flat and depressed lesions and serrated lesions. Optimal screening colonoscopy includes documentation of high quality by adequate adenoma detection rates, cecal intubation rates, and use of appropriate surveillance intervals.