结肠镜二次进镜法对结直肠息肉检出率的影响

[目的]总结结肠镜二次进镜法的操作方法，探讨其安全性、时间效益及对结直肠息肉检出率的影响。[方法]选取行无痛肠镜检查的846例患者，采用随机数字表法，分为二次进镜法组和常规组，每组423例，比较2组患者检查过程中血压、心率、呼吸及血氧饱和度的差异、操作时间(进镜时间、退镜时间)及在二次进镜法组中发现息肉数目及特征(数目、位置、部位、大小、形态、病理类型)。运用Logistic回归分析，分析结直肠息肉漏诊的独立影响因素。[结果]二次进镜法组和常规组患者在检查过程中血压、心率、呼吸及血氧饱和度比较均差异无统计学意义(P>0.05);二次进镜法的第2次进镜及退镜时间与常规组比较差异有统计学意义(P<0.05);二次进镜法对多发性息肉、小息肉、升结肠息肉、横结肠息肉、乙状结肠息肉和无蒂息肉有更高的检出率(P<0.05),结直肠息肉病理类型与漏诊无关(P>0.05);多因素分析结果显示多发息肉、小息肉、升结肠息肉、横结肠息肉、乙状结肠息肉及无蒂息肉均是息肉漏诊的独立危险因素(P<0.05)。[结论]二次进镜法安全、可有效的提高息肉的检出率，结直肠息肉的发生形式、大小...     

黑色先端帽辅助结肠镜对结直肠息肉检出率的影响:一项前瞻性随机对照研究

背景:结肠镜为检出各类结直肠息肉的标准方法,然而,常规结肠镜(CC)仍有可能漏诊部分病变。已有文献报道透明帽辅助结肠镜(THAC)可提高结直肠息肉的检出率,但黑色先端帽辅助结肠镜(BHAC)对结直肠息肉检出率的影响尚不明确。目的:评估BHAC对结直肠息肉检出率的影响。方法:前瞻性随机对照分析2014年9月—2015年4月复旦大学附属华东医院接受CC和BHAC检查的1 076例患者的临床资料,比较两组的一般资料、盲肠插入时间、退镜时间,以及息肉检出数、息肉检出率、息肉部位、大小、形态和病理学诊断。结果:与CC组相比,BHAC组盲肠插入时间显著缩短[(6.31±3.51)min对(7.05±4.15)min,P=0.002],退镜时间和盲肠插入率无明显差异(P0.05)。BHAC组息肉检出率显著高于CC组(65.4%对48.7%,P=0.004),两组息肉大小和形态均无明显差异(P0.05)。两组均未发生出血、穿孔等并发症。结论:与CC相比,BHAC可显著提高结直肠息肉检出率,并可显著缩短盲肠插入时间。     

结直肠息肉发病风险预测模型构建及其临床价值

目的探讨行结肠镜检查者罹患结直肠息肉的相关危险因素并构建预测模型。 方法回顾性分析2019年1月至2021年10月于南京中医药大学第二附属医院行结肠镜检查者共1 671例的临床资料。根据结肠镜结果将968例结直肠息肉患者纳入息肉组，703名无息肉病变的患者纳入无息肉组。收集患者年龄、性别、身高、体重、吸烟史、饮酒史、实验室检查结果和既往肠镜检查结果等多种因素，分析影响结直肠息肉发生的相关危险因素。应用R语言建立预测结直肠息肉发生风险的列线图模型，用Bootstrap法进行模型内部验证，采用列线图验证曲线及ROC曲线评价列线图的预测性能。 结果息肉组患者年龄（t=151.531，P＜0.001）、男性比例（χ²=50.843，P＜0.001）、长期吸烟史比例（χ²=5.034，P=0.013）、BMI（t=0.813，P＜0.001）、既往息肉史（χ²=8.323，P=0.004）高于无息肉组，差异有统计学意义。多因素Logistic回归模型分析结果显示：年龄，性别，BMI，长期吸烟，既往息肉大小、病理类型及生长位置为结直肠息肉发病的独立危险因素（均P＜0.05）。ROC曲线显示AUC为0.908，敏感性和特异性分别为76.9%和83.2%。 结论年龄，性别，长期吸烟史，BMI，既往息肉大小、病理类型及生长位置为结直肠息肉发病的独立危险因素。该研究所建立的列线图模型具有良好的区分度和准确度，可为直观、个体化地分析结直肠息肉发生风险，甄别高危人群，为临床制订筛查方案提供参考依据。     

结肠镜检查时退镜时间和结直肠息肉发现率的回顾性分析

目的 探讨结肠镜检查时退镜时间和结直肠息肉发现率的关系.方法 选取我院2012年6月～2012年8月接受结肠镜检查的患者556例,按息肉的有无分为有息肉组和无息肉组两组,并比较两组患者年龄、性别、肠道清洁度、息肉位置、大小、病理类型及完成全结肠镜检查的例数和退镜时间的差异,进一步将息肉组按退镜时间长短分为＜2分钟、2～4分钟、4～6分钟和＞6分钟4组,比较不同退镜时间息肉发现率的差异.结果 受检者556例,发现结直肠息肉者158例,无息肉者398例,两组患者性别、肠道清洁度及完成全结肠检查例数比较差异无统计学意义（P＞0.05）,两组患者年龄及退镜时间比较差异有统计学意义（P＜0.01）.不同退镜时间组受检者的年龄比较差异无统计学意义（P＞0.05）.Logistic回归分析显示,随着退镜时间的延长,息肉发现率逐渐增加,且差异有统计学意义（P＜0.01）,随退镜时间延长,息肉发现数目增加,Spearman相关分析显示两者的相关系数为0.32（P ＜0.01）.结论 结直肠息肉的发现率和发现数目随退镜时间的延长而增加,结直肠镜检查时退镜时间应＞6分钟.     

结直肠癌平均风险人群结肠镜检查盲肠进镜失败现状及原因

目的:获得我国结直肠癌平均风险人群结肠镜检查中盲肠进镜失败比例,分析失败病例特点并探讨导致进镜失败的原因.方法:采用回顾性分析方法,调取2008-01/2010-09于上海长海医院结肠镜检查室进行结肠镜检查的患者资料,按受检原因筛选平均风险人群,按照是否完成盲肠进镜分为两组,组间性别、年龄、肠道准备质量和息肉检出率差异应用χ2检验.对盲肠进镜失败原因进行描述性分析.结果:共有10164名平均风险受检者接受了结肠镜检查,其中盲肠进镜失败组613人,占6.0%.与盲肠进镜成功组患者相比,盲肠进镜失败组患者平均年龄和息肉检出率更高、肠道准备质量较差(P<0.05),性别比例无显著差别.导致狭窄的占位性病变是盲肠进镜失败的首要原因,肠道准备欠佳次之.盲肠进镜失败组中共检出浸润癌253例,浸润癌检出率为41.27%.结论:高龄、肠道准备欠佳是盲肠进镜失败的相关因素.盲肠进镜失败时腺瘤检出率偏高的现象与浸润癌的检出关系密切.我国平均风险人群结直肠进展期肿瘤检出率偏高.     

结肠镜进镜难度评价及其影响因素的研究进展

结肠镜检查在结直肠疾病的筛查、诊断和治疗中具有不可替代的作用.有效进镜是高质量结肠镜检查的基础.高进镜难度可导致插镜失败,造成结直肠病变漏诊率增加,而盲目进镜还会引起结直肠黏膜损伤、出血、穿孔等严重并发症.因此,科学评估进镜难度对成功实施结肠镜检查具有重要意义.但目前关于结肠镜进镜难度的评价体系尚缺乏统一的标准,盲肠插...     

联动成像模式对提高结直肠息肉检出率的有效性研究

目的 评估联动成像模式（linked color imaging，LCI)提高结直肠息肉检出率，尤其是腺瘤检出率的有效性。方法 回顾性分析2018年5月—2019年3月入院接受LASEREO系统结肠镜LCI模式或普通白光（white light imaging，WLI）模式检查的患者，比较两种模式下结肠镜检查整体息肉检出率、腺瘤检出率、扁平息肉检出率、小息肉(≤5 mm)检出率及右半结肠息肉检出率的差异。用国际照明委员会（Commission Internationale de L""Eclairage，CIE）于1976年制定的L*a*b*颜色空间分析比较两种模式下腺瘤性息肉与周边黏膜的色差（ΔE）。结果 LCI组患者整体息肉检出率，尤其是腺瘤检出率高于WLI组，差异有统计学意义(45.53%比32.83%，P=0.038；53.65%比39.62%，P=0.009)。LCI组腺瘤性息肉与周边黏膜的色差（ΔE）明显高于WLI组，差异有统计学意义（27.24±8.67比15.28±6.68，P<0.001），且LCI组扁平息肉、小息肉及右半结肠息肉检出率均高于WLI组，差异有统计学意义（61.98%比47.17%，P=0.005；60.94%比42.77%，P=0.001；45.83%比32.70%，P=0.012）。结论 LCI能有效提高结直肠息肉检出率，尤其是腺瘤检出率，值得临床推广应用。     

985例结直肠癌筛查高危人群肠息肉临床特征分析

背景:结直肠息肉为消化道的常见疾病,与结直肠癌的发生、发展关系密切。目的:探讨结直肠癌筛查高危人群中肠息肉的临床特点。方法:选取2013年4月—2014年12月粪便隐血试验阳性或结直肠癌高危因素调查表评价存在高危因素并在上海市第一人民医院分院接受结肠镜检查的虹口区社区居民。分析结直肠息肉的检出率、不同性别人群、年龄段的特征,以及结直肠息肉的发病部位、形态、病理类型等特点。结果:共985例息肉患者纳入本研究,息肉总体检出率为48.7%,男性检出率明显高于女性(58.7%对38.9%;χ~2=79.788,P0.01)。不同年龄段息肉检出率差异有统计学意义(χ~2=23.820,P0.01)。左半结肠息肉检出率明显高于右半结肠(62.4%对37.6%,χ~2=190.643,P0.01)。隆起型息肉0-Ⅰ的总体检出率94.5%,平坦型息肉0-Ⅱa为48.3%。腺瘤性息肉检出率高于非腺瘤性息肉(59.3%对47.1%,χ~2=27.326,P0.01)。119例患者的两次病理结果不一致。仅17.8%息肉摘除者术后行结肠镜随访,其中62.3%息肉复发。结论:结直肠癌筛查高危人群有较高的结直肠息肉发生率,高质量的结肠镜检查和及时有效的手术可降低结直肠癌的发生。     

代谢综合征组分与结直肠腺瘤性息肉复发关系的研究

背景：研究显示一些代谢综合征（MS）组分为结直肠腺瘤性息肉的危险因素,然而关注MS组分在结直肠腺瘤性息肉复发中意义的研究尚少。目的：研究MS组分与结直肠腺瘤性息肉复发的关系。方法：纳入2003年1月～2009年1月于北京大学人民医院行内镜下结直肠息肉切除术、病理诊断为腺瘤性息肉并有2年以上复查资料的成年患者,采集其包括4项MS组分（肥胖、高血压、高血糖、血脂异常）在内的12项可疑危险因素,筛选复发相关因素,以之为自变量,以研究起点之后第1～3年期间的结肠镜复查结果为因变量,行多元logistic回归分析,计算OR值并换算为RR值。结果：共138例患者纳入研究,76例（55.1%）在研究起点之后第1～3年期间复发,4例复查时发现结直肠癌年龄、高血压病史、糖尿病病史、饮酒史和多发性腺瘤以及伴发MS组分的数量与复发相关（P〈0.05）。logistic回归分析显示MS组分（OR=2.308,P〈0.01：RR=1.342）和年龄（OR=1.040,P〈0.05;RR=1.018）为复发的独立危险因素。结论：伴发MS组分的结直肠腺瘤性息肉更易复发,提示可将MS组分纳入结直肠腺瘤性息肉治疗后复查的参考指标。     

i-Scan电子染色技术在筛查右半结肠息肉样病变中的应用价值

目的 探讨内镜i-Scan模式在右半结肠息肉样病变检出中的价值。 方法 采用前瞻性、随机、自身对照的研究方法，以2015年1月至12月间在北京世纪坛医院接受结肠镜检查的200例患者为研究对象，常规观察右半结肠后，分别采用白光模式（白光组，93例）及i-Scan模式（i-Scan组，96例）再次观察右半结肠，比较两组右半结肠息肉及腺瘤的检出情况。 结果 两次检查i-Scan组人均息肉检出数显著多于白光组（1.469比1.011，P=0.028），第2次退镜多检出息肉的患者多于白光组[37.5％（36/96）比22.6％（21/93），P=0.025]，能够检出更多直径＜5 mm的息肉[84.0％（42/50）比58.3％（14/24），P=0.016]。i-Scan组人均腺瘤检出数量多于白光组（0.979比0.624，P=0.039），第2次退镜多检出腺瘤的患者多于白光组[24.0％（23/96）比11.8％（11/93），P=0.030]，两组多检出腺瘤的大小、部位、形态差异无统计学意义（P＞0.05）。i-Scan组与白光组的息肉检出率分别为61.5％（59/96）、48.4％（45/93）（P=0.071），腺瘤检出率分别为47.9％（46/96）、35.5％（33/93）（P=0.083）。 结论 内镜i-Scan模式可增加右半结肠息肉及腺瘤的检出，并提高多发息肉及腺瘤患者息肉样病变的检出及小息肉（直径＜5 mm）的检出。     

Sedation-risk-free colonoscopy for minimizing the burden of colorectal cancer screening

Unsedated colonoscopy is available worldwide, but is not a routine option in the United States (US). We conducted a literature review supplemented by our experience and expert commentaries to provide data to support the use of unsedated colonoscopy for colorectal cancer screening. Medline data from 1966 to 2009 were searched to identify relevant articles on the subject. Data were summarized and co-authors provided critiques as well as accounts of unsedated colonoscopy for screening and surveillance. Diagnostic colonoscopy was initially developed as an unsedated procedure. Procedure-related discomfort led to wide adoption of sedation in the US, although unsedated colonoscopy remains the usual practice elsewhere. The increased use of colonoscopy for colorectal cancer screening in healthy, asymptomatic individuals suggests a reassessment of the burden of sedation in colonoscopy for screening is appropriate in the US for lowering costs and minimizing complications for patients. A water method developed to minimize discomfort has shown promise to enhance outcomes of unsedated colonoscopy. The use of scheduled, unsedated colonoscopy in the US appears to be feasible for colorectal cancer screening. Studies to assess its applicability in diverse practice settings deserve to be conducted and supported.     

Preoperative colonoscopy through the colonic stent in patients with colorectal cancer obstruction

AIM:To evaluate the feasibility of a preoperative colonoscopy through a self-expendable metallic stent(SEMS)and to identify the factors that affect complete colonoscopy.METHODS:A total of 48 patients who had SEMS placement because of acute malignant colonic obstruction underwent preoperative colonoscopy.After effective SEMS placement,patients who showed complete resolution of radiological findings and clinical signs of acute colon obstruction underwent a standard bowel preparation.Preoperative colonoscopy was then performed using a standard colonoscope.If the passage of colonoscope was not feasible gastroscope was used.After colonoscopy,cecal intubation time,grade of bowel preparation,tumor location,stent location,presence of synchronous polyps or cancer,damage to colonoscopy and bleeding,and stent migration after colonoscopy were recorded.RESULTS:Complete evaluation with colonoscope was possible in 30 patients(62.5%).In this group,adenoma was detected in 13 patients(43.3%).The factors that affected complete colonoscopy were also analyzed:Tumor location at an angle;stent placement at an angle;and stent expansion diameter,which affected complete colonoscopy significantly.However in multivariate analysis,stent expansion diameter was the only significant factor that affected complete colonoscopy.Complete evaluation using additional gastroscope was feasible in 42 patients(87.5%).CONCLUSION:Preoperative colonoscopy through the colonic stent using only conventional colonoscope was unfavorable.The narrow expansion diameter of the stent may predict unfavorable outcome.In such a case,using small caliber scope should be considered and may expect successful outcome.     

Virtual colonoscopy for the detection of colorectal polyps and cancers in a Chinese population

AIM: The aim of this study is to assess the sensitivity of virtual colonoscopy in detecting colorectal polyps and cancers in a Chinese population. METHODS: Seventy-one consecutive Chinese patients (38 men and 33 women) referred for diagnostic colonoscopy were recruited. Patients received a routine bowel preparation in the morning followed by a helical abdominal computed tomography (CT) scan with air insufflation of the colon. The CT images were then processed by using surface-rendered software and interpreted by a single radiologist who was blinded to the clinical information. Colonoscopy was performed in the same afternoon without knowledge of the radiology results. All polyps and cancers were proven histologically. RESULTS: Five colorectal cancers were diagnosed and all were detected by virtual colonoscopy. The sensitivity and specificity of virtual colonoscopy for the detection of patients with polyps of all sizes, and patients with polyps >/=10 mm were 59, 92, 88 and 100%, respectively. The procedure was well tolerated by all patients. CONCLUSIONS: This study was carried out in a real clinical setting without a preselection of cases. Virtual colonoscopy was satisfactory for the detection of polyps greater than 10 mm, and for the diagnosis of cancer, and it is also a promising imaging modality for colorectal neoplasm detection in a Chinese population.     

Utility of single and double balloon endoscopy in patients with difficult colonoscopy: A randomized controlled trial

AIM: To compare the utility of single-balloon colonoscopy (SBC) or double-balloon colonoscopy (DBC) for difficult colonoscopies. METHODS: Between August 2008 and June 2010, patients in whom total colonoscopy failed within 30 min of insertion were assigned randomly to undergo either SBC or DBC. No sedatives were used. After the endoscopy, all patients were asked to evaluate pain during the procedure on a 10-point analog scale (1 = no pain; 10 = worst imaginable pain) with a questionnaire. The study outcomes were the cecal intubation rate and time, endoscopic findings, complications, and pain score. RESULTS: The SBC and DBC groups included 11 and 10 patients, respectively. All but one SBC patient achieved total colonoscopy successfully. The cecal intubation times were 18 min (range: 10-85 min) and 12.8 min (range: 9.5-42 min) in the SBC and DBC groups, respectively (P= 0.17). No difference was observed in the prevalence of colon polyps between the SBC and DBC groups (45% vs 30%, P = 0.66). SBC showed advanced colon cancer in the ascending colon, which was inaccessible using conventional colonoscopy. The respective pain scores were 5 (1-10) [median (range)] and 5 (1-6) in the SBC and DBC groups (P = 0.64). No complications were noted in any patient. CONCLUSION: The utility of singleand double-balloon endoscopy for colonoscopy seems comparable in patients with incomplete colonoscopy using a conventional colonoscope.     

A prospective randomised study comparing double-balloon colonoscopy and conventional colonoscopy in pre-defined technically difficult cases

Backgrounds and aimTechnically ‘difficult’ (TD) colonoscopy is associated with incomplete colonoscopy, discomfort and longer procedures. Double-balloon colonoscopy (DBC) may facilitate TD colonoscopy. The primary outcome was to compare the time taken to achieve caecal intubation during conventional colonoscopy (CC) and DBC in patient with a TD colon.MethodsWe performed a prospective, randomised study comparing DBC and CC for TD colonoscopy. Patients were screened for parameters predictive of TD colonoscopy using an original scoring system and randomised to DBC or CC. Pain, sedation dose, colonoscopy completeness, time taken for cecal intubation, procedure completion, recovery time and patient satisfaction were recorded.ResultsForty-four patients were recruited (DBC = 22; CC = 22). DBC facilitated total colonoscopy in 22 cases whereas 9 CC procedures were incomplete (P = 0.019). Median pre-procedure difficulty scores were equal for both groups (4.0 vs. 4.0). Mean patient discomfort, pain scores and recovery time were significantly lower for the DBC group (2.3 vs. 5.5, P = 0.001; 2.0 vs. 5.9, P = 0.005; 5 vs. 20 min, P = 0.014 respectively). Mean time taken for cecal intubation was similar (17.5 vs. 14 min, P = 0.18);ConclusionDBC facilitates colonoscopy completion and may be a more comfortable alternative to CC for TD cases although the time taken to achieve caecal intubation was similar.     

Sodium phosphate is superior to polyethylene glycol in bowel cleansing and shortens the time it takes to visualize colon mucosa

Background: Both sodium phosphate (NaP) and polyethylene glycol‐electrolyte (PEG‐EL) have been used to cleanse the bowel prior to colonoscopy, and recent reviews suggest that the former is the more effective and convenient cleansing regimen. The aim of this study was to compare the bowel cleansing effect of NaP solution with that of PEG‐EL solution and to evaluate whether the cleansing effect correlates with the time needed to perform colonoscopy. Methods: 111 patients admitted for colonoscopy were randomized to receive either 90?mL oral NaP or 4?litres of PEG‐EL solution. Cleansing was scored blindly by one colonoscopist and the following times were recorded: caecal intubation, withdrawal and total colonoscopy. Results: Of all the patients included in the study, 99 were evaluable. The mean and standard error of the mean (±s_x ) cleansing score was 3.64?±?0.16 in the NaP group and 2.69?±?0.9 in the PEG‐EL group (P?=?0.005). The mean (±s_x ) caecal intubation times were 6.39?±?0.50?min and 5.39?±?0.41?min (P?=?0.13), the withdrawal times 4.26?±?0.20?min and 5.78?±?0.34?min (P?=?0.0001) and the total colonoscopy times 10.65?±?0.52?min and 11.17?±?0.56?min (P?=?0.50) in the NaP and PEG‐EL groups, respectively. The subgroup of patients with a cleansing score of 3 or more was associated with shortened colonoscopy withdrawal time compared to the group scoring below 3. Conclusions: Better cleansing of the large bowel shortens colonoscopy withdrawal time. Sodium phosphate is a more effective bowel‐cleansing regimen than polyethylene glycol, and the better cleansing result is associated with shortened colonoscopy withdrawal time.     

无痛与常规电子结肠镜检查效果的对照分析

目的通过总结和分析2200例电子结肠镜检查结果,揭示本地下消化道疾病患病情况,同时探讨无痛肠镜的可行性和安全性。方法回顾性分析2200例受检者年龄结构、性别比例和发病情况,同时比较2200例中的无痛肠镜受检者（A组,n=1039）和常规肠镜受检者（B组,n=1161）两组之间的阳性率和不良反应发生情况;A组从静脉依次缓慢注入咪唑安定0.01mg/kg、芬太尼0.001mg/kg和丙泊酚1～1.5mg/kg;B组按常规方法进行肠镜检查;专人评估受检者的术中和术后恢复情况及不良反应。结果结肠镜检查的阳性率91.32%,A、B两组阳性率无差异（P〉0.05）。患病谱依次为慢性结/直肠炎、大肠息肉、痔疮、大肠癌、炎症性肠病、结肠憩室、血管畸形和阑尾结石。严重不良反应发生率为0.14%,A、B两组术中和术后的HR、BP及SpO2无明显差异（P〉0.05）,不良反应发生率A组显著低于B组（P〈0.001）,且肠镜检查成功率A组高于B组（P〈0.05）,用时A组明显短于B组（P〈0.01）。结论无痛电子结肠镜与常规电子结肠镜相比,检出的阳性率无明显差异,但成功率高、操作时间短、受检者和操作医生感觉舒适。不增加不良反应发生率。     

Screening colonoscopy:The present and the future

In the United States,colorectal cancer(CRC)is the second leading cause of mortality in men and women.We are now seeing an increasing number of patients with advanced-stage diagnosis and mortality from colorectal cancer before 50 years of age,which requires earlier screening.With the increasing need for CRC screening through colonoscopy,and thus endoscopists,easier and simpler techniques are needed to train proficient endoscopists.The most widely used approach by endoscopists is air insufflation colonoscopy,where air distends the colon to allow visualization of the colonic mucosa.This technique is uncomfortable for patients and requires an anesthetist to administer sedation.In addition,patients commonly complain about discomfort post-op as air escapes into the small bowel and cannot be adequately removed.Current research into the use of water insufflation colonoscopies has proved promising in reducing the need for sedation,decreasing discomfort,and increasing the visibility of the colonic mucosa.Future direction into water insufflation colonoscopies which have shown to be simpler and easier to teach may increase the number of proficient endoscopists in training to serve our aging population.