结肠镜筛查203例无症状人群结直肠癌及腺瘤检出率分析

目的了解澳门无症状人群通过肠镜筛查的结直肠癌及腺瘤检出率及其临床特征。 方法选择2012年1月至12月于我院进行肠镜检查的无症状人群203例,回顾性分析其临床特征和病理活检结果,并分析肠癌及腺瘤患者的高危因素。 结果203例受检者中检出结肠癌3例(1.48%),腺瘤70例(34.48%),其中高危腺瘤30例(14.78%)。60岁以上受检者腺瘤检出率高于50岁以下受检者(P＝0.013),有吸烟史人群高危腺瘤检出率高于无吸烟史者(P＝0.037)。 结论对无症状人群的全结肠镜筛查有助于早期发现肠癌及腺瘤。年龄大于60岁是结肠腺瘤的高危因素,吸烟史是结肠高危腺瘤的高危因素。     

OMOM胶囊内镜在无症状人群体检中的应用

目的 探讨OMOM胶囊内镜在无症状人群体检中应用价值.方法 受检者为2005年8月-2010年3月到北京军区总医院消化内科进行胶囊内镜检查的无症状体检人群,受检者按就诊的时间顺序随机分为研究组(A组)、对照组(B组)、自身对照组(C组).A组受检者按一定体位进行胶囊内镜检查,送服胶囊后立即依次平卧位3 min,左侧卧位3 min,右侧卧位3 min,半卧位3min,观察食管黏膜情况,再观察胃依次左侧卧位10 min,平卧位10 min,右侧卧位10 min,站立位10 min,随后可自由活动,直至胶囊内镜排出体外.B组受检者按常规要求进行胶囊内镜检查.C组受检者进行胶囊内镜检查后即安排胃镜和结肠镜检查.结果 A组和B组胶囊内镜食管运行平均时间和胃排空平均时间差异均有统计学意义(P＜0.05);但A组和B组胶囊内镜排出平均时间差异无统计学意义(P＞0.05).A组和C组胶囊内镜食管运行平均时间和排出平均时间差异均有统计学意义(P＜0.05);但A组和C组胶囊内镜胃排空平均时间差异无统计学意义(P＞0.05).90例A组受检者中检出消化道病变者28例,检出率31.11％;160例B组受检者中检出消化道病变者42例,检出率26.25％;110例C组受检者中检出消化道病变者43例,检出率39.09％.A组和B组食管病变检出率比较差异具有统计学意义(P＜0.05).结论 胶囊内镜在特定体位下可以提高食管及胃病变检出率.胶囊内镜检查可以指导胃镜及结肠镜检查能更有效提高消化道疾病检出率,用于无症状人群体检无疑是一种安全、无创、无痛苦的消化道检查方法.     

529例健康体检者结肠镜检查结果分析

目的 探讨健康人群体检时进行结肠镜检查的意义.方法 选取北京协和医院体检中心于2010年1月至2011年6月期间接受结肠镜检查的健康体检者537例,其中529例成功接受了全结肠镜检查.统计受检者的性别、年龄、病变检出情况,包括检出率、类型、部位,并分析息肉检出率、病变部位与年龄和性别间的关系.结果 529例受检者中男315例、女214例,平均年龄(48.3±9.3)岁,检出肠息肉104例(19.7％),其中进展期息肉17例(3.2％),腺瘤84例(15.9％),直肠癌1例(0.2％),痔疮61例(11.5％),结直肠炎症22例(4.2％).结直肠息肉在男性中的检出率显著高于女性(P＜0.001).年龄≥50岁者结直肠息肉和进展期息肉的检出率均明显升高(P＜0.001,P＜0.05).共检出息肉158枚,以＜0.5 cm、管状腺瘤居多.随年龄增长,近端结肠息肉患者的比例增多,而远端结肠息肉患者的比例减少(P＜0.05).结论 结肠镜检查是筛查健康体检人群结直肠病变的有效手段,重视体检人群的结肠镜检查有助于结直肠癌的早发现早治疗.     

体检人群非酒精性脂肪性肝病检出率及其相关因素分析

目的探讨广东地区不同年龄段体检人群非酒精性脂肪性肝病(NAFLD)患病率及相关因素。方法对20047例体检人群进行B超和血生化学检查。结果本组体检人群NAFLD检出率为13.2%,其中单纯性非酒精性脂肪肝检出率为8.7%(1731/20047),非酒精性脂肪性肝炎为4.5%(910/20047),未检出肝硬化和肝癌;随年龄增长,NAFLD检出率逐渐增高,其中60~70岁年龄组人群检出率为25.6%,50~60岁年龄组为23.8%,与小于30岁组、30-岁组、40-岁组和70-岁组比,差异有统计学意义(分别为4.7%、10.8%、17.6%和18.7%,P<0.01);男性人群NAFLD检出率高于女性(18.8%对7.8%,P<0.01),但在60岁以上人群,男性与女性NAFLD检出率无明显差别(22.1%对22.4%,P=0.883);NAFLD患者合并高血压、高血糖、高甘油三酯血症和高胆固醇血症的发生率均高于无NAFLD人群(35.2%对11.7%,14.4%对2.6%,46.8%对10.1%,31.8%对2.5%,P<0.01)。结论 NAFLD的发病与年龄、性别及高血压、高血糖、高甘油三酯血症和高胆固醇血症等因素相关。     

胶囊内镜在无症状人群体检中的应用价值

目的探讨胶囊内镜在无症状人群体检中的应用价值。方法回顾性分析2013年3月至2014年9月期间282例无症状体检者在爱康国宾体检中心采用胶囊内镜行消化道检查的临床资料,观察胶囊内镜检查的耐受性、安全性、消化道各段运行时间以及病变检出情况。结果 282例受检者中,276例(97.9%)顺利完成胶囊内镜检查,66.3%(183/276)发现消化道病变,57.6%(159/276)检出小肠病变,所检出小肠病变以淋巴管扩张、非特异性小肠炎(充血、糜烂、散在浅溃疡)、十二指肠炎、十二指肠糜烂、毛细血管扩张等多见。胶囊在胃内平均运行时间为(55.0±72.7)min,在小肠内平均运行时间为(243.6±102.6)min。检查过程中,受检者无不适感。受检者均于检查后72 h内排出胶囊。结论小肠病变在无症状人群中的检出率并不低,胶囊内镜作为一种无创、简便、安全、有效的消化道检查手段,应用于无症状人群的体检中,有助于小肠病变的早期检出,为小肠疾病的早期诊断、早期治疗提供有力依据。     

3280例健康体检者结肠镜检查结果分析

对无症状人群进行结直肠癌早期筛查以降低其发病率和死亡率具有非常重要的意义.对高危人群进行结肠镜检查被认为是发现结直肠癌及癌前病变的最佳方法.现就近年来在我院进行体检者的结肠镜检查情况进行分析,报道如下. 一、资料与方法 1.临床资料:回顾2008至2010年中石化宁波市镇海炼化分公司员工接受结肠镜健康体检资料,记录受检者的性别、年龄、结肠镜表现、临床表现、胃癌结肠癌家族史、息肉部位、大小、数目、病理类型等资料.受检者共3280例,其中男1980例,女1300例,年龄26～ 86岁,平均54.96岁.按照年龄分层,青年组(≤40岁)252例,中年组(＞40 ～60岁)2139例,老年组(＞ 60岁)889例.     

老年健康体检人群血尿酸水平及高尿酸血症的分布特点

目的分析老年健康体检人群血尿酸(SUA)水平及高尿酸血症(HUA)的分布特点。方法选取2 753例老年健康体检者,对所有的体检者进行空腹静脉血检查,并将HUV与年龄、性别、高血压、糖尿病及心血管疾病等进行单因素分析,将相关因素与HUV的检出率进行多因素分析。结果 60～70岁男性人群SUA水平明显高于70岁及以上人群(P0.05),70岁及以上女性人群SUA水平明显高于60～70岁人群(P0.05);60岁以上男性人群的SUA水平明显高于60以上女性人群(P0.05);不同年龄老年健康体检人群HUA检出率差异有统计学意义(P0.05),不同性别老年健康体检人群HUA检出率差异有统计学意义(P0.05);2 753例健康体检者共检出HUA282例,男223例,女59例;男性HUA检出率(13.75%)明显高于女性(5.22%,P0.05)。男性、年龄、超重、高血压、高三酰甘油、低密度脂蛋白胆固醇升高是引发HUA的危险因素(P0.05)。结论男性HUA发生率明显高于女性;超重,三酰甘油异常、高血压、低密度脂蛋白胆固醇异常等人群中,发生HUA的风险较高,在预防HUA中需对上述因素提高警惕。     

结直肠癌平均风险人群结肠镜检查的息肉与腺瘤检出率及其年龄分布情况

目的探讨我国结直肠癌平均风险人群结肠镜检查中的息肉检出率和腺瘤检出率及其年龄分布情况,为确定我国结直肠癌筛查起始年龄提供线索和数据支持。方法采用回顾性分析方法,调取2010年3月至2013年2月间进行“体检肠镜”检查的患者资料,按照不同性别、年龄组、肠道准备质量分别计算息肉检出率和腺瘤检出率。各组间率比较采用z。检验。结果共有1928例患者完成体检全结肠镜检查。总的息肉检出率为19．55％[95％CI（17．78％-21．32％）],男性为23．87％,女性为10．00％。40～70岁各年龄组息肉检出率男性均显著高于女性（P〈0．05）。总的腺瘤检出率为11．48％[95％CI（9．69％～13．28％）],男性为14．68％,女性为5．11％。40—70岁各年龄组腺瘤检出率男性均显著高于女性（P〈0．05）。肠道准备优良组息肉检出率显著优于较差组（P〈0．05）。结论息肉检出率和腺瘤检出率均随年龄增长而提高,男性较之女性有更大的息肉、腺瘤发生风险。肠道准备质量对息肉检出率有直接的影响。     

从高危人群中筛选早期胃癌的临床研究

为提高早期胃癌检出率,作者前瞻性地对271例胃癌高危人群和105例普通胃病就诊者开展了内镜及病理诊断的比较研究。结果高危人群组检出胃癌22例,其中早期胃癌14倒(占胃癌63. 6％);普通就诊者内镜检查发现胃癌5例,无一为早期胃癌。结果表明,高危人群随访复查检出早期胃癌的有效性明显为高。     

体检人群高血糖筛查情况分析及对策

广州地区2005年参加健康体检人群74651例,按年龄每5岁为一组,分别统计各组受检人数与高血糖例数.结果 20岁以上人群空腹高血糖、IFG和糖尿病的检出率分别为10.23%、6.28%和3.95%,且随年龄增长而增高;男性(12.46%、7.95%、4.86%)均显著高于女性(5.97%、3.75%、2.22%),性别之间有非常显著差异(P＜0.0005);30岁以上男性达到糖尿病诊断标准者占5.82%,40岁以上女性占3.85%.结论 糖尿病的一级预防男性应从30岁开始,女性可推迟到40岁.糖尿病的预防重点应放在IFG和糖耐量受损(IGT)人群.     

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.     

乙状结肠二次进镜对于腺瘤性息肉检出率影响的研究

目的在结肠镜检查中运用二次进镜观察乙状结肠的方法,研究乙状结肠腺瘤性息肉检出率的影响。 方法选取2020年12月1~31日经包头医学院第二附属医院内镜中心行结肠结检查的1 800例患者,随机抽取900例患者进行乙状结肠的二次进镜观察,分析乙状结肠单次进镜与二次进镜的腺瘤性息肉检出率情况。 结果1 800例结肠镜检查的患者中,共832例患者检查结肠腺瘤性息肉,其中乙状结肠单次进镜共检出乙状结肠腺瘤780枚,乙状结肠二次进镜共检出乙状结肠腺瘤1 080枚。 结论在本研究中,乙状结肠二次进镜可提高乙状结肠腺瘤性息肉检出率,对降低发展为结肠癌的风险具有重要的临床意义。     

上海松江区结直肠癌普查研究的初步结果

目的探讨粪便隐血试验结合大肠镜检查作为大肠癌普查方式的可行性。方法2006年9月至2007年5月,对上海市松江区无症状且结直肠癌普通危险度的≥50岁人群以及40～49岁志愿参加普查者行免疫组化法粪便隐血试验,连续3次排便中任意2次粪便标本送检,对任何1次粪便隐血阳性（包括弱阳性）的患者行全结肠镜检查。对息肉的数量、分布位置及病理结果进行统计。结果≥50岁受检者共2692例,粪便隐血试验阳性者184例,阳性率6．8％,共56例患者发现了64枚结肠息肉,包括腺瘤性息肉34枚、炎性息肉15枚、增生性息肉15枚,发现直肠癌1例。40～49岁志愿普查者共582例,隐血试验呈阳性者28例,阳性率4．8％,共6例患者发现了6枚息肉,包括腺瘤性息肉1枚、炎性息肉5枚,并发现肠癌2例。多数息肉分布于左半结肠。结论对无症状的结直肠癌普通危险度人群的普查能较早发现结肠息肉,对粪便隐血试验阳性的患者行全结肠镜检查可能较适合社区及广大农村地区结直肠癌的大规模普查。     

Epidemiology of polyps in the rectum and sigmoid colon. Histological examination of resected polyps

In an endoscopic screening study of rectosigmoidal polyps in a defined normal population aged 50-59 years, polyps 5 mm or larger in diameter were removed by diathermic snare resection for histological examination. Histological examination was possible in 50 of 55 polyps removed during colonoscopy from 27 men and 17 women. Of these polyps 41 (82%) were adenomas--12 with moderate dysplasia, 1 with severe dysplasia, and 2 with intramucosal carcinoma. In addition, a small ulcerating carcinoma, Dukes stage A, was found. A greater extent of dysplasia was found in rectosigmoidal adenomas in women, whereas more polyps were found in both distal and proximal parts of the colon among men. The size of adenomas and degree of dysplasia were unrelated to color of the lesions.     

Screening for Colon Malignancy with Colonoscopy

Screening of asymptomatic individuals for colon malignancy has been advocated for the past 20 yr in the hopes of reducing colon cancer mortality. Although sigmoidoscopy is an important element of current screening recommendations, the sensitivity of this test in asymptomatic subjects has never been studied. The purpose of this study was to determine the prevalence and location of polyps and cancers in an asymptomatic population by performing full colonoscopy. We wished to assess the sensitivity of screening flexible sigmoidoscopy to 60 cm by determining how many patients with adenomas or cancer had "index" adenomatous polyps in the distal 60 cm. One hundred five healthy male outpatients, over 50 yr old, with negative examinations for occult blood in stools and no prior history of colon pathology, had full colonoscopy. Careful examination of the distal 60 cm was performed, followed by a full colon examination to the cecum. Forty-three patients (41%) had adenomatous polyps, and only 19 of these patients had an index adenomatous polyp in the distal 60 cm. Therefore, the sensitivity of sigmoidoscopy was 44%. The prevalence of adenomas increased with age. Patients were assigned to one of three groups based on the findings in the distal 60 cm. Group 1 (n = 65) had no polyps in the distal 60 cm, but 18 of these patients (28%) had adenomatous polyps in the proximal colon. Among 21 patients with only hyperplastic polyps in the distal 60 cm (group 2), six patients (29%) had proximal adenomas. In group 3, eight of 19 patients (42%) with adenomas in the distal 60 cm also had proximal adenomatous polyps. We conclude that adenomatous polyps are common in asymptomatic men who have negative tests for fecal occult blood. Sigmoidoscopy to 60 cm had a sensitivity of only 44% in this patient population, suggesting that this is an insensitive test for the detection of patients with adenomatous polyps.     

Colonic Neoplasms in Asymptomatic First-Degree Relatives of Colon Cancer Patients

First-degree relatives of colon cancer patients are at elevated risk for developing colorectal neoplasms. In order to assess the potential usefulness of screening by colonoscopy in this high-risk population, we reviewed the records of 48 colonoscopies performed on asymptomatic patients who were self- or physician-referred for colonoscopy because of a history of one or more first-degree relatives with colon cancer. Twelve (25%) had at least one adenomatous polyp, but no significant atypia was detected. No cancers were detected. One third of the lesions were beyond the reach of a flexible sigmoidoscope. This apparent increase in the prevalence of adenomas was most striking (46%) among men over the age of 50. These preliminary results demonstrate that colonoscopy is effective in detecting and removing adenomatous polyps in a substantial fraction of asymptomatic patients whose sole risk-factor is being a first-degree relative of a patient with colon cancer. Further studies in larger populations are warranted to determine the use of colonoscopy in screening these high-risk individuals.     

Clinical usefulness of single-balloon endoscopy in patients with previously incomplete colonoscopy

AIM: To evaluate the clinical usefulness of single-balloon endoscopy (SBE) in patients in whom a colonoscope was technically difficult to insert previously.METHODS: The study group comprised 15 patients (8 men and 7 women) who underwent SBE for colonoscopy (30 sessions). The number of SBE sessions was 1 in 7 patients, 2 in 5 patients, 3 in 1 patient, 4 in 1 patient, and 6 in 1 patient. In all patients, total colonoscopy was previously unsuccessful. The reasons for difficulty in scope passage were an elongated colon in 6 patients, severe intestinal adhesions after open surgery in 4, an elongated colon and severe intestinal adhesions in 2, a left inguinal hernia in 2, and multiple diverticulosis of the sigmoid colon in 1. Three endoscopists were responsible for SBE. The technique for inserting SBE in the colon was basically similar to that in the small intestine. The effectiveness of SBE was assessed on the basis of the success rate of total colonoscopy and the presence or absence of complications. We also evaluated the diagnostic and treatment outcomes of colonoscopic examinations with SBE.RESULTS: Total colonoscopy was successfully accomplished in all sessions. The mean insertion time to the cecum was 22.9 ± 8.9 min (range 9 to 40). Abnormalities were found during 21 sessions of SBE. The most common abnormality was colorectal polyps (20 sessions), followed by radiation colitis (3 sessions) and diverticular disease of the colon (3 sessions). Colorectal polyps were resected endoscopically in 15 sessions. A total of 42 polyps were resected endoscopically, using snare polypectomy in 32 lesions, hot biopsy in 7 lesions, and endoscopic mucosal resection in 3 lesions. Fifty-six colorectal polyps were newly diagnosed on colonoscopic examination with SBE. Histopathologically, these lesions included 2 intramucosal cancers, 42 tubular adenomas, and 2 tubulovillous adenomas. The mean examination time was 48.2 ± 20.0 min (range 25 to 90). Colonoscopic examination or endoscopic treatment with SBE was not associated with any serious complications.CONCLUSION: SBE is a useful and safe procedure in patients in whom a colonoscope is technically difficult to insert.     

Endotics system vs colonoscopy for the detection of polyps

AIM: To compare the endotics system (ES), a set of new medical equipment for diagnostic colonoscopy, with video-colonoscopy in the detection of polyps. METHODS: Patients with clinical or familial risk of colonic polyps/carcinomas were eligible for this study. After a standard colonic cleaning, detection of polyps by the ES and by video-colonoscopy was performed in each patient on the same day. In each single patient, the assessment of the presence of polyps was performed by two independent endoscopists, who were randomly assigned to evaluate, in a blind fashion, the presence of polyps either by ES or by standard colonoscopy. The frequency of successful procedures (i.e. reaching to the cecum), the time for endoscopy, and the need for sedation were recorded. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the ES were also calculated. RESULTS: A total of 71 patients (40 men, mean age51.9 ± 12.0 years) were enrolled. The cecum was reached in 81.6% of ES examinations and in 94.3% of colonoscopies (P = 0.03). The average time of endoscopy was 45.1 ± 18.5 and 23.7 ± 7.2 min for the ES and traditional colonoscopy, respectively (P < 0.0001). No patient required sedation during ES examination, compared with 19.7% of patients undergoing colonoscopy (P < 0.0001). The sensitivity and specificity of ES for detecting polyps were 93.3% (95% CI: 68-98) and 100% (95% CI: 76.8-100), respectively. PPV was 100% (95% CI: 76.8-100) and NPV was 97.7% (95% CI: 88-99.9). CONCLUSION: The ES allows the visualization of the entire colonic mucosa in most patients, with good sensitivity/specificity for the detection of lesions and without requiring sedation.     

The Sentinel Hyperplastic Polyp: A Marker for Synchronous Neoplasia in the Proximal Colon

We prospectively screened 129 asymptomatic subjects (mean age 64 yr) with flexible sigmoidoscopy. Colonoscopy was performed at a later date, regardless of the sigmoidoscopic result. Our intent was 1) to establish the prevalence of proximal neoplasms in patients with and without hyperplastic polyps within reach of the 60-cm sigmoidoscope and 2) to determine whether a distal (sentinel) hyperplastic polyp predicts the presence of synchronous neoplastic polyps higher up in the colon. Our results show that 15% of asymptomatic adult subjects without polyps on sigmoidoscopy have adenomas in proximal colonic segments that can be diagnosed only by colonoscopy. By comparison, proximal neoplasms were detected in 32% (p less than 0.05) and 37% (p less than 0.05) of patients when hyperplastic or adenomatous polyps, respectively, were present on the sigmoidoscopic examination. This finding suggests that a distal (sentinel) hyperplastic polyp by itself may be a marker for neoplastic polyps in proximal colonic segments. Also, the "index" adenoma and "sentinel" hyperplastic polyp may be equivalent for predicting the presence of proximal neoplasms. The observed detection rates for these polyps were both significantly higher than expected when compared to patients who did not have polyps in the distal colon or rectum. If these results can be confirmed by a larger prospective trial, then full colonoscopy for detection of proximal neoplasms may be indicated when either an index adenoma or sentinel hyperplastic polyp is detected by sigmoidoscopy.     

New endoscopy devices to improve population adherence to colorectal cancer prevention programs

Despite recent advances in medicine, colorectal cancer (CRC) remains one of the greatest hazards for public health worldwide and especially the industrialized world. It has been well documented with concrete data that regular screening colonoscopy aimed at early detection of precancerous polyps can help decrease the incidence of CRC. However, the adherence of the general population to such screening programs has been shown to be lower than that expected, thus allowing CRC to remain a major threat for public health. Various reasons have been suggested to explain the disappointing compliance of the population to CRC screening programs, some of them associated with colonoscopy per se, which is viewed by many people as an unpleasant examination. Governments, medical societies, individual gastroenterologists, as well as the medical industry are working in order to improve endoscopic devices and/or to improve standard colonoscopy. The aim is to improve the acceptance of the population for this method of CRC screening, by providing a painless and reliable examination of the colon. This review focuses on some of the latest improvements in this field.