聚乙二醇电解质散联合莫沙必利用于结肠镜检查前肠道准备有效性和安全性的Meta分析

背景　肠道清洁对于结肠镜检查的准确性和安全性有重要意义,部分临床随机对照研究认为聚乙二醇电解质散联合莫沙必利可提高结肠镜前肠道准备的清洁效果和安全性,但此类研究结果不一致且存在一定争议性,有必要对此类研究进行系统评价。目的　旨在系统评价聚乙二醇电解质散联合莫沙必利对比单纯应用聚乙二醇电解质散在肠镜检查前行肠道准备的有效性与安全性。方法　计算机检索中国知网（CNKI）、万方数据知识服务平台、中文科技期刊数据库（VIP）、中国生物医学文献数据库（CMB）、PubMed、EMBase、Cochrane Library等数据库,检索时间为建库到2018年6月,全面收集聚乙二醇电解质散联合莫沙必利用于结肠镜检查前肠道准备的临床随机对照试验。由2名研究人员各自独立完成文献阅读,按照文献纳入、排除标准进行文献筛选、资料提取。采用RevMan 5.3软件进行Meta分析,采用GRADE profiler 3.6软件对Meta分析结局指标进行证据分级。结果　共纳入14篇文献,Meta分析结果显示,在肠道准备有效性方面,两亚组观察组肠道准备有效率均高于对照组〔RR=1.15,95%CI（1.06,1.25）,P=0.000 8;RR=1.03,95%CI（1.01,1.06）,P=0.02〕;在安全性方面,观察组总不良反应发生率〔RR=0.54,95%CI（0.44,0.67）,P<0.000 01〕、恶心发生率〔RR=0.48,95%CI（0.39,0.60）,P<0.000 01〕、呕吐发生率〔RR=0.46,95%CI（0.32,0.65）,P<0.000 1〕、腹胀发生率〔RR=0.36,95%CI（0.26,0.50）,P<0.000 01〕均低于对照组。两组腹痛发生率和息肉检出率比较,差异无统计学意义〔RR=0.79,95%CI（0.58,1.08）,P=0.14;RR=0.90,95%CI（0.74,1.10）,P=0.32〕。结论　聚乙二醇电解质散联合莫沙必利行肠道准备的有效性和安全性均优于单纯应用聚乙二醇电解质散。在未来需要高质量文献纳入以进一步证实本研究结果。     

基于云服务平台的健康教育在门诊结肠镜检查患者肠道准备中的应用效果郭琦1, 王萍2上海徐汇区中心医院,上海 200031；2.复旦大学附属中山医院,上海 200032)

目的 探讨基于云服务平台的健康教育对门诊结肠镜检查患者肠道准备依从性及肠道准备质量的影响。方法 选择2018年5月-2019年7月门诊预约行结肠镜检查患者800例为研究对象,随机分为观察组400例、对照组400例。两组均给予相同的结肠镜检查肠道准备健康教育内容,对照组采用发放健康手册、口头介绍等常规健康教育形式,观察组采用基于云服务平台的健康教育,比较两组结肠镜检查患者肠道准备依从性、肠道准备质量、不良反应等指标。结果 观察组结肠镜检查患者饮食管理、服药管理、肠道运动、并发症预防依从性高于对照组[(98.50% vs 95.75%)、(95.25% vs 90.50%)、(96.00% vs 91.00%)、(93.75% vs 88.50%](x2=5.417, 6.819, 8.2257, 6.816, P<0.05)。右侧结肠、横结肠、左侧结肠、总体液体积聚量、渥太华肠道准备评分量表(OBPS)评分低于对照组[(0.96±0.45 vs 1.22±0.52)、(.16±0.42 vs 1.32±0.48)、(0.68±0.12 vs 0.75±0.18)、(0.42±0.18 vs 0.46±0.22)、(3.22±0.78 vs 3.75±0.82)](t=7.562, 5.017, 6.472, 2.814, 9.366, P<0.05, P<0.01)。腹胀、腹痛发生率低于对照组[(19.50% vs 28.50%)、(3.25% vs 8.25%)](x2=8.882, 7.181, P<0.05)。结论 基于云服务平台的健康教育有助于促进结肠镜检查患者肠道准备依从行为的养成,对于提高肠道准备质量、预防不良反应事件的发生,有着积极的应用价值。     

Multidetector CT colonoscopy: evaluation of the perspective-filet view virtual colon dissection technique for the detection of elevated lesions

Background The purpose of our study was to determine the usefulness of a virtual computed tomography colon dissection visualization technique for the detection of polypoid lesions in comparison with conventional virtual colonoscopy analysis and optical colonoscopy. Methods Twenty-three patients were evaluated with optical colonoscopy and computed tomography colonoscopy using 16-row MDCT on the same day. CT images were analyzed by the colon dissection workup with unfolded haustra visualization and also using the conventional virtual colonoscopy technique (axial images and endoluminal views). The CT analysis was performed by an experienced radiologist using both viewing methods in a randomized order and blinded to optical colonoscopy results. Results Optical colonoscopy revealed 35 colonic lesions; 15 < 5 mm, 18 between 5–9 mm and 2 > 9 mm. For conventional virtual colonoscopy analysis the overall sensitivity was 86.67%; for the colon dissection visualization technique, the overall sensitivity was 82.86%. The average reading time for conventional virtual colonoscopy was 15 ± 3 vs. 8 ± 2 min for the colon dissection visualization technique. Conclusions Our results showed that there is a significant reduction in the reading time using the colon dissection visualization technique without detriment to the detection rate, that is, competitive to conventional virtual colonoscopy interpretation results. There are no conflicts of interest in connection with the submitted article.     

The role of colonoscopy and flexible sigmoidoscopy in screening for Colorectal Carcinoma

Six hundred thirty-two patients were referred to the Colorectal Clinic from February 1983 to February 1986 for screening with the Pentax 65 cm flexible sigmoidoscope. Forty-nine of these patients (8 percent) had adenomatous polyps. There were 27 males and 22 females. The mean distance examined by the 65 cm flexible sigmoidoscope was 55 cm. Five patients were excluded from analysis, leaving 44 patients who underwent colonoscopy to the cecum. At the time of colonoscopy, 15 of the 44 patients (34 percent) had one or more adenomatous polyps beyond reach of the 65 cm flexible sigmoidoscope. The remaining 29 patients who underwent colonoscopy had no polyps beyond reach of the 65 cm flexible sigmoidoscope. Thirty adenomatous polyps, one invasive carcinoma of the ascending colon, and one hyperplastic polyp were found in these 15 patients. In summary, 34 percent of patients found to have adenomatous polyps within reach of the 65 cm flexible sigmoidoscope harbored one or more adenomatous polyps in the proximal colon at the time of colonoscopy. A positive 65 cm flexible sigmoidoscope examination requires colonoscopy to identify and remove proximal premalignant lesions, thereby aborting the polyp-cancer sequence.     

Factors associated with colonoscopy performed in nonhospital settings

BACKGROUND:

Colonoscopy is being increasingly performed in facilities outside of hospitals. Regulation of these facilities is variable, and concerns regarding the quality of procedures in nonhospital (NH) settings have been raised. Further study is needed to better understand endoscopic practice in these facilities.

OBJECTIVES:

To describe NH-based colonoscopy practice in Ontario from 1993 to 2005, and to identify patient (age, sex, income quintile and comorbidity) and physician (specialty and colonoscopy volume) factors associated with this practice.

METHODS:

The present study was a population-based, cross-sectional analysis using health administrative data from Ontario adults who underwent at least one outpatient colonoscopy between 1993 and 2005. A total of 1,240,781 patients underwent 1,917,714 colonoscopies. The main outcome measure was the receipt of colonoscopy in an NH facility.

RESULTS:

An increase in NH-based colonoscopy from 10.0% in 1993 to 15.1% in 2005 (P<0.0001) was found. In the multivariate model, younger, healthier men living in higher income areas were significantly more likely to undergo NH-based colonoscopy. Surgeons and other practitioners (eg, nongastroenterologists and noninternists) were significantly more likely to practice in NH settings. Physicians in the highest colonoscopy volume quintile were 25 times more likely to practice in NH settings than those in the lowest volume quintile (P<0.0001).

CONCLUSION:

Rates of NH-based colonoscopy are rising in Ontario. High-volume endoscopists and surgeons are most likely to practice in NH settings. Given its increasing use, further study of the practice and the regulation of NH colonoscopy is warranted.     

Colonoscopic evaluation of minimal rectal bleeding in average-risk patients for colorectal cancer

AIM： To assess the prevalence of clinically significant lesions in patients with minimal bright red bleeding per rectum （BRBPR）. METHODS： Consecutive outpatients prospectively underwent colonoscopy at Loghman Hakim Hospital, Tehran. Minimal BRBPR was defined as small amounts of red blood after wiping or in the toilet bowl. Patients with the following alarm signs were excluded： Positive personal history of colorectal neoplasms or inflammatory bowel disease （IBD）, positive first degree family history of colorectal neoplasms, history of altered bowel habits, recent significant weight loss, and presence of iron deficiency anemia. Neoplastic polyps, colorectal carcinoma, and IBD were defined as significant lesions. RESULTS： A total of 402 patients （183 female and 219 male, aged 43.6 ± 15.7 years） were studied. Hemorrhoids （54.2%）, anal fissures （14.2%） and ul- cerative colitis （14.2%） were the most common lesions and colonoscopy was normal in 8.0%. Significant lesions were found in 121 （30.1%） patients, including 26 patients （6.5%） with adenocarcinoma and 30 （7.5%） with adenomatous polyps. Almost all patients with significant lesions had at least one lesion in the distal colon; an adenocarcinoma and an adenomatous polyp in the proximal colon were found in 2 patients with hemorrhoids. CONCLUSION： Flexible sigmoidoscopy appears to be sufficient for the evaluation of average risk patients with minimal BRBPR. Rigid sigmoidoscopy may be used as an alternative in patients less than 40 years of age in settings where the former is not available. Thechoice of colonoscopy over flexible sigmoidoscopy in patients aged over 50 years should be individualized.     

Management of Small Polyps Detected by Screening CT Colonography: Patient and Physician Preferences

Background

Management of small polyps found on computed tomography (CT) colonography is controversial and critical to both cancer outcomes and cost. Patient and physician behavior are influenced by personal beliefs and prior experience. Thus, we aimed to understand patient and physician preferences after finding polyps on CT colonography.

Methods

Patients were given a validated handout and survey asking for their preference for evaluation of a “pea-sized” polyp found on CT colonography. By using an Internet survey, physicians were asked how they would manage a 5-mm, 8-mm, or 12-mm polyp, or three 5-mm polyps found by CT colonography in a hypothetical 52-year-old patient of average colorectal cancer risk. Survey reliability was assessed using Cronbach's coefficient alpha.

Results

Of the 305 patient respondents, 95% wanted to know if the polyp found on CT colonography was precancerous, 86% stated they would request endoscopic evaluation, and 85% wanted polypectomy. Of the 277 primary care physicians, 71% would refer a 5-mm sigmoid polyp for endoscopy, 86% would refer an 8-mm polyp, 97% would refer a 12-mm polyp, and 91% would refer three 5-mm polyps. Of the 461 gastroenterologists, 83% would refer a 5-mm sigmoid polyp for endoscopy, 96% would refer an 8-mm polyp, 97% would refer a 12-mm polyp, and 93% would refer three 5-mm polyps. Overall, 75% of physicians indicated the fear of missing a precancerous lesion would prompt referral for colonoscopy.

Conclusion

Both patients and physicians overwhelmingly preferred to follow up small polyps identified by CT colonography with endoscopy, suggesting that population-based CT colonography screening programs in which polyps are not removed might require significant patient and physician education before implementation.     

The cleansing result of oral sodium phosphate is inversely correlated with time between the last administration and colonoscopy

Background There is some evidence that the timing of sodium phosphate (NaP) ingestion affects the cleansing result. The objective of this study was to evaluate the correlation of cleansing result with the timing of ingestion of NaP. Methods 214 consecutive outpatients scheduled to undergo colonoscopy were enrolled in the study. All patients filled out a detailed questionnaire concerning the execution of bowel cleansing. Concomitant with colonoscopy, patient characteristics were recorded and after the procedure the cleansing result was scored. The correlation between cleansing score and time from the last dose of NaP to colonoscopy was evaluated. For further analysis, patients were divided into three groups regarding the time lag from NaP taking to colonoscopy (group 1, 6 h or less; group 2, 6–12 h; group 3, 12 h or more). Results 204 patients had complete colonoscopy and enough data to be analyzed for the study. The Pearson correlation coefficient for the time between the last dose of NaP and colonoscopy was -0.450 (p=0.0001) showing an inverse correlation. The mean cleansing score (±SEM) of group 1 was 4.00±0.12, for group 2 it was 3.56±0.12, and for group 3 it was 2.64±0.14. There were statistically significant differences between all groups. Conclusion The cleansing result of NaP is inversely correlated with the time between last dose of NaP and colonoscopy. Colonoscopy should be preferably performed within 12 hours of taking the second dose of NaP.