乳果糖在结肠镜检查前肠道准备的应用及研究进展

乳果糖在国内外常用作肠道准备药物,但目前尚缺乏关于此方面的系统综述。本文将就乳果糖在结肠镜检查前肠道准备的应用情况与研究现状作一综述,以期为临床工作提供一定参考。     

聚乙二醇电解质散在结肠镜检查前肠道准备中的应用观察

将498例行结肠镜检查的患者随机分为实验组(240例)和对照组(258例),实验组口服聚乙二醇电解质散清肠,对照组口服果导加硫酸镁清肠.发现实验组肠道准备时间较对照组明显缩短,P＜0.05;两组清洁肠道有效率及肠腔内气泡情况无明显差异;实验组不良反应明显少于对照组;耐受性实验组优于对照组.认为聚乙二醇电解质散应用于结肠镜检查前肠道准备安全有效,准备时间短.     

Bristol粪便性状评估表在儿童结肠镜检查前肠道准备中的应用研究

目的 评价Bristol粪便性状评估表（BSFS）用于儿童结肠镜检查前肠道准备的临床价值,并探讨其影响因素。 方法 采用方便抽样方法,以2016年5月至2016年12月收治于复旦大学附属儿科医院消化科拟行结肠镜检查的患儿为研究对象,经排除标准排除后共202例患儿纳入研究,统一使用聚乙二醇-4000分剂量服用联合饮食限制行肠道准备的方案。术前使用BSFS评估每次解便的性状,检查当日6∶00查看最近1次解便的性状,BSFS≤5分者加服聚乙二醇-4000（20 mL／kg）,11∶00查看末次解便的性状,BSFS≤5分者取消当日结肠镜检查并延长肠道准备时间,BSFS 6分者予温生理盐水灌肠（灌肠组）,BSFS 7分者不予温生理盐水灌肠（不灌肠组）。13∶00行结肠镜检查,术中使用Boston肠道准备评分表（BBPS）记录镜下视野清晰度,分为优、良、一般、差,其中优、良定义为肠道准备合格。灌肠组和不灌肠组肠道准备合格率比较使用卡方检验。按肠道准备是否合格分成2组（合格组和不合格组）,根据数据类型,使用t（或t′）检验或卡方检验分析肠道准备质量的影响因素,单因素分析筛选出的因素再纳入多因素logistic回归分析,以寻求影响肠道准备质量的独立危险因素。检验水准为α=0.05。 结果 202例患儿在肠道准备期间平均排便次数为（14.4±6.8）次,不灌肠组165例（81.7％）,灌肠组37例（18.3％）,肠道准备合格患儿154例（76.2％）,其中不灌肠组肠道准备合格率为75.2％（124／165）,灌肠组肠道准备合格率为81.1％（30／37）,2组肠道准备合格率比较差异无统计学意义（χ2=0.587,P=0.526）。单因素分析发现,合格组与不合格组在便秘史（χ2=32.588,P=0.000）、解便总次数（t=3.432,P=0.001）、BSFS 7分的次数（t′=2.877,P=0.005）方面差异有统计学意义。进一步多因素logistic回归分析显示,便秘史是肠道准备不合格的独立危险因素（P=0.000,OR=12.620,95％CI：4.850～32.800）。 结论 对于儿童结肠镜检查前的肠道准备,术前肉眼观察粪便性状并采用BSFS进行把控具有较好的临床应用价值,肠道准备合格率较高。但对于有便秘史的患儿,建议适当延长肠道准备时间以确保镜下视野清晰度。     

实时肠道准备评估系统(ENDOANGEL)在结肠镜检查肠道准备质量评估中的应用

目的 探讨实时肠道准备评估系统(ENDOANGEL)在结肠镜检查肠道准备质量评估中的应用价值。方法 前瞻性纳入2021年3—12月湖北医药学院附属襄阳市第一人民医院消化内镜检查患者1 360例,随机分为ENDOANGEL辅助结肠镜检查组(680例)和常规结肠镜检查组(680例),进行肠道清洁度的判断和评价。在常规结肠镜检查组中,内镜医师和护士在退镜阶段使用BBPS量表的肠道清洁质量评分评估肠道准备的质量。在内镜辅助系统(ENDOANGEL)结肠镜检查组退镜阶段增加了内镜系统辅助技术,其他技术保持不变。结果 ENDOANGEL内镜辅助结肠镜组肠道准备质量评分的准确度明显优于常规结肠镜组,差异有统计学意义(P<0.05),两组在3分的准确度上无显著性差异(P> 0.05),但ENDOANGEL内镜辅助结肠镜组的0分、1分和2分评分准确度高于常规结肠镜组,差异有统计学意义(P<0.05)。结论 ENDOANGEL可用于评价结肠镜的准备质量,具有较好的特异性和敏感性。它可以帮助内镜医师在结肠镜检查过程中进行实时监测,积极提示肠道清洁度评分,避免观察者的判断偏差,提高结肠镜检查...     

便秘患者结肠镜检查的肠道准备

我院近２年来对便秘患者肠道准备采用电解质液加服硫酸镁的方法，肠道清洁效果明显好于单独服用电解质液。共２００例，按口服电解质液及加服硫酸镁分组，每组１００例。电解质液组：氯化钠６．１４g、氯化钾０．７５g、碳酸氢钠２．９４g溶于１０００ml温开水中，３倍量共３０００ml溶液于检查前４～５h在３０～６０min内饮完。电解质液加服硫酸镁组，检查前４～５h服５０％硫酸镁３０ml后２０～３０min再服电解质液（方法如上）。结果加服硫酸镁者肠腔清洁度良好为９５％，不服硫酸镁者肠腔清洁度良好仅为５３％。讨论口服电解质液是目前…     

乳果糖和聚乙二醇电解质散联合应用在结肠镜检查前肠道准备中的价值

[目的]对比分析乳果糖口服液联合聚乙二醇电解质散Ⅰ或Ⅳ与单用聚乙二醇电解质散Ⅰ或Ⅳ进行肠道准备的效果差异。[方法]采用随机对照方式,将300例拟行结肠镜检查者分为以下4组,试验①组74例(服用乳果糖口服液和聚乙二醇电解质散Ⅰ)和对照①组75例(单纯服用聚乙二醇电解质散Ⅰ),以及试验②组75例(服用乳果糖口服液和聚乙二醇电解质散Ⅳ)和对照②组76例(单纯服用聚乙二醇电解质散Ⅳ)。[结果]经波士顿肠道准备评分量表评分,试验①组、对照①组分别为(7.14±0.68)分、(6.21±1.13)分,2组比较差异有统计学意义(P=0.000);试验②组、对照②组分别为(7.05±0.78)分、(6.13±1.06)分,2组比较差异亦有统计学意义(P=0.000)。到达回盲部所用时间,试验①组为(8.50±1.74)min,对照①组为(9.42±1.90)min,2组间差异无统计学意义(P=0.223);试验②组为(8.70±1.63)min,对照②组为(9.31±1.58)min,2组间差异亦无统计学意义(P=0.241)。大肠息肉检出率:试验①组22.97%,对照①组18.67%,2组比较差异无统计学意义P=0.255);但试验①组息肉直径≤0.5 cm者检出率显著高于对照①组(P=0.032);大肠息肉检出率:试验②组25.33%,对照②组19.74%,2组比较差异无统计学意义(P=0.286);但试验②组息肉直径≤0.5 cm者检出率显著高于对照②组(P=0.037)。试验组与对照组的不良反应比较差异亦无统计学意义。[结论]在结肠镜检查前的肠道准备中,联用乳果糖口服液和聚乙二醇电解质散比单用聚乙二醇电解质,可以明显改善患者的肠道准备效果,提高小息肉的检出率,且安全性好、经济实用。     

微视频结合团体集中肠道准备宣教在老年结肠镜检查与患者肠道清洁中的效果

目的 分析微视频结合团体集中肠道准备宣教在老年结肠镜检查与治疗患者中的应用.方法 选取老年结肠镜检查与治疗患者,随机分为干预组120例,应用微视频结合团体集中肠道准备宣教;对照组120例应用常规的肠道准备宣教.评价两组肠道清洁效果相关指标.结果 干预组肠道准备依从性、肠道准备耐受度、肠道准备清洁度、肠道准备宣教满意度均...     

结肠镜检查不同时间行肠道准备质量比较

目的 比较结肠镜检查时不同时间行肠道准备的质量.方法 将2019-10～2020-01该院接受结肠镜检查的非麻醉门诊及住院患者130例,按随机数字表法分为观察组(64例)和对照组(66例).观察组于清晨5:00～7:00口服结肠清洁剂,上午完成结肠镜检查.对照组于上午10:00～12:00口服结肠清洁剂,下午完成结肠镜...     

电子结肠镜检查术前不同饮食准备方法比较

我们2002-01／2003-12对接受电子结肠镜检查的300例病人，行术前3种饮食准备的对比，现将结果报道总结如下。     

伊托必利在结肠镜检查前肠道准备中的应用

目的 观察伊托必利在结肠镜检查前肠道清洁准备中的应用效果.方法 选取门诊和住院的患者198例,随机分为复方聚乙二醇电解质散组和复方聚乙二醇电解质散联合伊托必利组,观察结肠镜检查前肠道准备的情况.结果 两组患者肠道准备总有效率复方聚乙二醇电解质散组85.0%、伊托必利组93.9%,两组比较差异有统计学意义(P<0.05);伊托必利组服用药物后不良反应低于复方聚乙二醇电解质散组,差异有统计学意义(P<0.05).结论 复方聚乙二醇电解质散联合伊托必利肠道准备疗效优于单用复方聚乙二醇电解质散者.     

Esophagogastroduodenoscopy-assisted bowel preparation for colonoscopy

AIM: To compare the quality and tolerance of esophagogastroduodenoscopy (EGD)-assisted and conventional split-dose polyethylene glycol electrolyte solution for inpatient colonoscopy.METHODS: The study was a randomized controlled trial in hospitalized patients. Hospitalized patients undergoing colonoscopy the day following EGD for evaluation of gastrointestinal (GI) bleeding or other symptoms. Patients randomized to either EGD-assisted bowel prep [2 L polyethylene glycol (PEG) administered endoscopically into distal duodenum at time of EGD, plus 1 L PEG orally the following day] or conventional-PEG (2 L PEG orally the evening prior and 1 L PEG orally the following day). The main outcome measurements are bowel preparation quality and patient tolerance of bowel prep.RESULTS: Forty-two patients randomized to EGD-assisted bowel prep and 40 patients to conventional-PEG. Overall mean ± SD preparation quality was superior for EGD-PEG (4.1 ± 2.8) vs conventional-PEG (6.5 ± 3.1; P = 0.0005). Seventy-four percent of patients rated EGD-PEG as easy or slightly difficult to tolerate compared to 46% for standard-PEG (P = 0.0133). Mean EGD-procedural time was greater for EGD-assisted subject (24 ± 10 min) compared to conventional-PEG prep subjects (15 ± 7 min; P < 0.0001). Conscious sedation requirements did not differ between groups. There were no significant prep-related adverse events in either group.CONCLUSION: In selected hospitalized patients, compared to a conventional split-dose regimen, use of EGD to administer the majority of PEG solution improves patient tolerance and quality of bowel preparation for colonoscopy.     

Predictors of inadequate bowel preparation for colonoscopy

OBJECTIVE: Inadequate preparation of the bowel for colonoscopy can result in both missed pathological lesions and cancelled procedures. We looked prospectively at the quality of colonic preparation and evaluated potential associations between specific patient characteristics and inadequate colonic preparation. METHODS: Data were gathered on consecutive patients presenting for colonoscopy who received either a polyethylene glycol lavage or oral sodium phosphate bowel preparation. Patient demographic and medical history information was gathered before scheduled colonoscopy. The endoscopist evaluated the preparation quality during the procedure. Complete data were gathered on 649 of 714 eligible patients (90.8%). Possible predictors of inadequate colonic preparation were analyzed using univariate statistics and multivariate logistic regression models. RESULTS: An inadequate colonic preparation was reported in 21.7% of observed colonoscopies. Only 18% of patients with an inadequate colonic preparation reported a failure to adequately follow preparation instructions. A later colonoscopy starting time, a reported failure to follow preparation instructions, inpatient status, a procedural indication of constipation, taking tricyclic antidepressants, male gender, and a history of cirrhosis, stroke or dementia were all independent predictors of an inadequate colon preparation (all p < 0.05). A procedural indication of previous polypectomy was a negative predictor of inadequate colonic preparation (p < 0.05). CONCLUSION: Several patient characteristics were significantly associated with colonic preparation quality independent of preparation type, compliance with preparation instructions, and procedure starting time. This information may help to identify patients at an increased risk for inadequate colonic preparation for whom alternative preparation protocols would be appropriate.     

Evidence-based considerations on bowel preparation for colonoscopy

We recently read with interest the article, “Novel frontiers of agents for bowel cleansing for colonoscopy”. This is a practical narrative review, which could be of particular importance to clinicians in order to improve their current practice. Although we appreciate the venture of our colleagues, based on our in-depth analysis, we came across several minor issues in the article; hence, we present our comments in this letter. If the authors consider these comments further in their relevant research, we believe that their contribution would be of considerable importance for future studies.     

Achieving the best bowel preparation for colonoscopy

Bowel preparation is a core issue in colonoscopy, as it is closely related to the quality of the procedure. Patients often find that bowel preparation is the most unpleasant part of the examination. It is widely accepted that the quality of cleansing must be excellent to facilitate detecting neoplastic lesions. In spite of its importance and potential implications, until recently, bowel preparation has not been the subject of much study. The most commonly used agents are high-volume polyethylene glycol (PEG) electrolyte solution and sodium phosphate. There has been some confusion, even in published meta-analyses, regarding which of the two agents provides better cleansing. It is clear now that both PEG and sodium phosphate are effective when administered with proper timing. Consequently, the timing of administration is recognized as one of the central factors to the quality of cleansing. The bowel preparation agent should be administered, at least in part, a few hours in advance of the colonoscopy. Several low volume agents are available, and either new or modified schedules with PEG that usually improve tolerance. Certain adjuvants can also be used to reduce the volume of PEG, or to improve the efficacy of other agents. Other factors apart from the choice of agent can improve the quality of bowel cleansing. For instance, the effect of diet before colonoscopy has not been completely clarified, but an exclusively liquid diet is probably not required, and a low-fiber diet may be preferable because it improves patient satisfaction and the quality of the procedure. Some patients, such as diabetics and persons with heart or kidney disease, require modified procedures and certain precautions. Bowel preparation for pediatric patients is also reviewed here. In such cases, PEG remains the most commonly used agent. As detecting neoplasia is not the main objective with these patients, less intensive preparation may suffice. Special considerations must be made for patients with inflammatory bowel disease, including safety and diagnostic issues, so that the most adequate agent is chosen. Identifying neoplasia is one of the main objectives of colonoscopy with these patients, and the target lesions are often almost invisible with white light endoscopy. Therefore excellent quality preparation is required to find these lesions and to apply advanced methods such as chromoendoscopy. Bowel preparation for patients with lower gastrointestinal bleeding represents a challenge, and the strategies available are also reviewed here.     

Factors influencing quality of bowel preparation for colonoscopy

Recent technological advances in colonoscopy have led to improvements in both image enhancement and procedural performance.However,the utility of these technological advancements remain dependent on the quality of bowel preparation during colonoscopy.Poor bowel preparation has been shown to be associated with lower quality indicators of colonoscopy performance,such as reduced cecal intubation rates,increased patient discomfort and lower adenoma detection.The most popular bowel preparation regimes currently used are based on either Polyethylene glycol-electrolyte,a non-absorbable solution,or aqueous sodium phosphate,a lowvolume hyperosmotic solution.Statements from various international societies and several reviews have suggested that the efficacy of bowel preparation regimes based on both purgatives are similar,although patients’ compliance with these regimes may differ somewhat.Many studies have now shown that factors other than the type of bowel preparation regime used,can influence the quality of bowel preparation among adult patients undergoing colonoscopy.These factors can be broadly categorized as either patient-related or procedure-related.Studies from both Asia and the West have identified patient-related factors such as an increased age,male gender,presence of co-morbidity and socioeconomic status of patients to be associated with poor bowel preparation among adults undergoing routine out-patient colonoscopy.Additionally,procedure-related factors such as adherence to bowel preparation instructions,timing of bowel purgative administration and appointment waiting times for colonoscopy are recognized to influence the quality of colon cleansing.Knowledge of these factors should aid clinicians in modifying bowel preparation regimes accordingly,such that the quality of colonoscopy performance and delivery of service to patients can be optimised.