住院患者结肠镜检查前肠道准备质量提高的研究进展

<正>结肠镜检查可以清楚发现肠道病变,同时还可对部分肠道病变进行治疗,目前广泛应用于结直肠息肉、炎症性肠病、结直肠早期肿瘤的诊断及治疗。中国结直肠癌筛查与早诊早治指南^[1]指出结肠镜检查是结直肠癌筛查普遍应用的金标准。良好的肠道准备率应>85%。     

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。     

如何选择结肠镜检查前的肠道准备方案

结肠镜是目前在全球广泛使用的一种检查方法,它可以检测结肠及末端回肠的病变。肠道黏膜的清洁程度直接影响到检查的效果,这依靠事前充分的肠道准备工作。不充分的肠道准备可能会遗漏黏膜的损伤、延长检查的时间、增加患者的痛苦以及增加并发症的发生率。     

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…     

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...     

慢性便秘患者结肠镜检查前肠道准备改良效果研究

[目的]对慢性便秘患者结肠镜检查前的肠道准备方法进行改良并对比3种不同方法对肠道准备效果的影响。[方法]收集2014-01--2015-12期间接受结肠镜检查并常规使用复方聚乙二醇电解质散(PGE)的慢性便秘患者(便秘组)及非便秘患者(非便秘组)各100例。分析2组患者的清肠效果。选取2016-1-2018-05期间行结肠镜检查的200例慢性便秘患者,随机分为3组,即常规PGE组(常规组)65例、改良PGE组68例、改良硫酸镁组67例,观察受检者的肠道清洁程度,同时记录肠镜检查完成时间、不良反应、总体耐受性等。[结果]在常规使用聚乙二醇作肠道准备时,便秘组的清肠合格率为61.0%(61/100),显著低于非便秘组的80.0%(80/100),P0.01。清肠合格率改良PGE组(79.4%,54/68)、改良硫酸镁组(80.6%,54/67)均显著高于常规组(60.0%,39/65),P0.05;而改良PGE组与改良硫酸镁组的清肠合格率比较差异无统计学意义(P0.05)。3组患者结肠镜检查完成时间、不良反应及总体耐受性比较均差异无统计学意义(P0.05)。[结论]慢性便秘患者常规方法清肠合格率低,改良肠道准备后可显著提高便秘患者的清肠合格率,且不良反应小,患者耐受性好,值得进一步推广。     

结肠镜检查前肠道准备清洁效果的临床对比研究

目的：观察不同方法对结肠镜检查前肠道准备的清洁效果及其副作用。方法：312例结肠镜检查者肠道清洁前随机分为口服甘露醇组（A组）、口服番泻叶组（B组）、结肠循环冲洗组（C组）及联合B方法与C方法（D组）。据结肠镜检查中肠道清洁程度（I－Ⅲ级）和清洁范围（0－4度）评价肠道清洁效果。结果：D组肠道清洁程度和清洁范围最理想，其肠道清洁程度满意－比较满意率（I＋Ⅱ：96．2％）显著高于A组（82．1％；P＜0．01）、B组（85．7％；P＜0．05）和C组（69．3％，P＜0．01）。C组降结肠以下清洁率（65．4％）显著高于A组（37．1％，P＜0．01）和B组37．7％，P＜0．01），同时其肠道清洁失败率（30．8％）也显著高于B组（14．3％，P＜0．01）。此外，C组副作用发生率（3．8％）显著低于其他三组（A组43．6％，B组54．5％和D组58．2％，P均＜0．01）。结论：口服水泻剂联合结肠途径治疗机循环冲洗法是比较理想的全结肠清洁方法，单纯结肠循环冲洗法适合于乙状结肠镜检查前肠道准备。     

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.     

两种肠道准备方法在结肠镜检查前肠道准备的效果比较

目的:探索结肠镜检查前有效、方便的肠道准备方法.方法:将81例拟行结肠镜检查的患者随机分为观察组和对照组.观察组39例采用复方大承气汤与复方聚乙二醇电解质散联合口服清洁肠道;对照组42例采用单纯复方聚乙二醇电解质散口服清洁肠道.观察肠道清洁满意度和患者不良反应.结果:观察组肠道清洁满意度92.3%,对照组肠道清洁满意度为92.9%,差异无统计学意义(P0.05);观察组在恶心、呕吐、腹胀方面的不良反应明显少于对照组(P0.05).结论:采用复方大承气汤加复方聚乙二醇电解质散口服用于结肠镜检查前肠道准备,患者舒适度提高,减少药物用量,降低医疗费用,肠道内气泡较少,有利于医师操作和诊断.     

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.     

Improving quality of colonoscopy by adding simethicone to sodium phosphate bowel preparation

AIM： To evaluate the effectiveness of simethicone in enhancing visibility and efficacy during colonoscopy.
METHODS： A prospective, double-blind, randomized, placebo-controlled study was conducted. One hundred and twenty-four patients were allocated to receive 2 doses of sodium phosphate plus 240 mg of tablet simethicone or placebo as bowel preparation. Visibility was blindly assessed for the amount of air bubbles and adequacy of colon preparation. Total colonoscopic time, side effects of the medication, endoscopist and patient satisfaction were also compared.
RESULTS： Sodium phosphate plus simethicone, compared to sodium phosphate plus placebo, improved visibility by diminishing air bubbles （100.00% vs 42.37%, P 〈 0.0002） but simethicone failed to demonstrate improvement in adequacy of colon preparation （90.16% vs 81.36%, P = 0.17）. Endoscopist and patient satisfaction were increased significantly in the simethicone group. However, there was no difference in the total duration of colonoscopy and side effects of the medication.
CONCLUSION： The addition of simethicone is of benefit for colonoscopic bowel preparation by diminishing air bubbles, which results in enhanced visibility. Endoscopist and patient satisfaction is also increased.     

Low-volume plus ascorbic acid vs high-volume plus simethicone bowel preparation before colonoscopy

AIM:To investigate the effectiveness of low-volumeplus ascorbic acid [polyethylene glycol plus ascorbicacid(PEG + Asc) ] and high-volume plus simethicone[polyethylene glycol plus simethicone(PEG + Sim) ]bowel preparations.METHODS:A total of one hundred and forty-fourout patients(76 males) ,aged from 20 to 84 years(me-dian age 59.5 years) ,who attended our Department,were divided into two groups,age and sex matched,and underwent colonoscopy. Two questionnaires,onefor patients reporting acceptability and the ...     

The impact of patient education on the quality of inpatient bowel preparation for colonoscopy

BACKGROUND:

For patients requiring colonoscopy while admitted to hospital, achieving adequate cleansing of the colon is often difficult.

OBJECTIVES:

To assess the impact of patient education, in the form of both counselling and written instructions, on bowel cleanliness at colonoscopy.

METHODS:

A total of 38 inpatients at a tertiary care hospital in Vancouver, British Columbia, who were referred to the gastroenterology service for colonoscopy were enrolled in the present study. Sixteen patients were randomly assigned to the intervention group, while 22 patients comprised the control group. Both groups received a clear liquid diet and 4 L of a commercially available bowel preparation. The intervention group also received a brief counselling session and written instructions outlining the methods and rationale for bowel preparation before colonoscopy. Bowel cleanliness was assessed by the endoscopist using a five-point rating scale.

RESULTS:

The two groups were similar with respect to demographics, the indication for colonoscopy and findings at colonoscopy. The median bowel cleanliness scores in the control group and the enhanced-instruction group were 3.0 and 2.0, respectively (P=0.001).

CONCLUSION:

Patient counselling and written instructions are inexpensive, safe and simple interventions. Such interventions are an effective means of optimizing colonoscopy preparation in the inpatient setting.     

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.     

利那洛肽联合复方聚乙二醇在结肠镜肠道准备中应用的初步研究

目的　初步探索利那洛肽联合复方聚乙二醇（polyethylene glycol,PEG）在结肠镜肠道准备中的作用。方法　本试验是一项多中心随机对照研究。连续纳入2021年11月—2022年3月在上海长海医院、山西省人民医院和联勤保障部队第九〇〇医院3家消化内镜中心接受结肠镜检查的受试者,采用完全随机法分成3组,A组肠道准备方案为3 d利那洛肽+3 L PEG,B组为仅3 L PEG,C组为3 d利那洛肽+2 L PEG。主要观察指标为肠道准备合格率,次要观察指标包括肠道准备优秀率、肠道准备完成率以及肠道准备愿意重复率。结果　共入组130例受试者,其中A组46例,B组43例,C组41例,3组受试者肠道准备合格率［95.7%（44/46）、93.0%（40/43）和95.1%（39/41）,χ2=0.465,P=0.893］,肠道准备优秀率［43.5%（20/46）、25.6%（11/43）和34.1%（14/41）,χ2=3.151,P=0.207］及肠道准备完成率［95.7%（44/46）、95.3%（41/43）和100.0%（41/41）,χ2=1.909,P=0.544］差异均无统计学意义。3组受试者愿意再次行相应肠道准备方案的愿意重复率差异有统计学意义［89.1%（41/46）、74.4%（32/43）和100.0%（41/41）,χ2=12.862,P=0.002］。C组受试者肠道准备完成率和愿意重复率均为100.0%,较A、B两组有升高趋势。结论　利那洛肽有提高肠道准备质量的趋势,可以减少PEG用量。     

Effectiveness of polyethylene glycol antegrade gut lavage bowel preparation for colonoscopy—timing is the key!

PURPOSE: Polyethylene glycol gut lavage is an effective bowel preparation for colonoscopy. The quality of the preparation is not uniform however, and most studies report a rate of suboptimal cleansing of 10 percent or more. One of the possible reasons for a poor preparation is the length of time between the lavage and the examination. The aim of this study was to assess the effect of timing of polyethylene glycol gut lavage on the quality of the preparation achieved. METHODS: Patients referred for elective outpatient colonoscopy with afternoon appointments were randomized to take polyethylene glycol gut lavage either the same morning as their examination (Group 1) or the afternoon of the day before (Group 2). The colonoscopist was unaware of the preparation timing until after the examination was over. During the examination the endoscopist scored the quality of bowel preparation in the cecum, ascending colon, and transverse and left colon. Patient demographics and clinical data were recorded. RESULTS: There were 157 patients in Group 1 (colonoscopy complete in 152 patients) and 160 in Group 2 (colonoscopy complete in 159 patients). The groups were similar in age and gender, indication for colonoscopy, and previous colonic surgery. Patients who drank gut lavage on the morning of their colonoscopy had a greatly better preparation in all areas of the colon than the patients who took their preparation the night before. In the cecum, 97 Group 1 patients had an excellent preparation (vs. 14 Group 2 patients), 45 had a good preparation (vs. 103 Group 2 patients), and 10 had a fair preparation (vs. 33 Group 2 patients). In the ascending colon, numbers of patients with excellent, good, fair, and poor results were 103, 45, 5, and 0 for Group 1 and 12, 107, 32, and 7 for Group 2. Results in the transverse and left colons were 102, 50, 5, 0 and 93, 55, 7, 2 for Group 1 and 15, 116, 27, 5 and 18, 114, 24, 3 for Group 2, respectively. CONCLUSION: The timing of administration of polyethylene glycol-based gut lavage is a major determinant of the quality of the bowel preparation achieved.Presented at the Tripartite Meeting of Colorectal Surgical Societies in Sydney, Australia, October 17 to 20, 1993.     

The optimal bowel preparation intervals before colonoscopy: A randomized study comparing polyethylene glycol and low-volume solutions

Background & aimsThe optimal duration of bowel preparation has only been assessed for polyethylene glycol (PEG). The aim of the study was to determine the intervals for achieving a satisfactory quality/tolerability of the preparation using PEG/ascorbic acid (PEGA) and sodium picosulphate/magnesium citrate (SPMC), and to compare them with 4L of PEG.MethodsA randomized, endoscopist-blinded, multicentre study. The 612 outpatients referred to a colonoscopy, were prepared using PEG, SPMC, PEGA. The quality, tolerability, duration of the preparation, and the interval from the end of the preparation to the colonoscopy was assessed.ResultsOptimum duration of the preparation was similar for both PEG and SPMC (≥7.3 vs. ≥8.8 h, overall ≥8.4 h). Optimum interval to the colonoscopy was ≤11.8 h and did not differ between preparations (PEG, PEGA ≤ 11.8, SPMC ≤ 13.3 h). These times were the only predictors for a satisfactory preparation. The tolerability depends on the product type (SPMC) only. Timing of the preparation or the other factors had no impact on tolerability.ConclusionThe optimum intervals for bowel preparation are identical for all preparations. Satisfactory preparation is achived at the preparation length ≥8.4 h and the time to colonoscopy ≤11.8 h.     

Improving the quality of colonoscopy bowel preparation using an educational video

Colonoscopy is the preferred modality for colon cancer screening. A successful colonoscopy requires proper bowel preparation. Adequate bowel preparation continues to remain a limiting factor. One hundred thirty-three patients scheduled for an outpatient colonoscopy were prospectively randomized in a single-blinded manner to video or nonvideo group. In addition to written bowel preparation instructions, patients in the video group viewed a brief instructional video. Quality of colon preparation was measured using the Ottawa Bowel Preparation Quality scale, while patient satisfaction with preparation was evaluated using a questionnaire. Statistical analyses were used to evaluate the impact of the instructional colonoscopy video. There were significant differences in the quality of colonoscopy preparation between the video and the nonvideo groups. Participants who watched the video had better preparation scores in the right colon (P=0.0029), mid-colon (P=0.0027), rectosigmoid (P=0.0008), fluid content (P=0.03) and aggregate score (median score 4 versus 5; P=0.0002). There was no difference between the two groups with regard to patient satisfaction. Income, education level, sex, age and family history of colon cancer had no impact on quality of colonoscopy preparation or patient satisfaction. The addition of an instructional bowel preparation video significantly improved the quality of colon preparation.     

Analysis of YouTube~(TM) videos related to bowel preparation for colonoscopy

AIM: To examine YouTubeTM videos about bowel preparation procedure to better understand the quality of this information on the Internet. METHODS: YouTubeTM videos related to colonoscopy preparation were identified during the winter of 2014; only those with ≥ 5000 views were selected for analysis(n = 280). Creator of the video, length, date posted, whether the video was based upon personal experience, and theme was recorded. Bivariate analysis was conducted to examine differences between consumers vs healthcare professionals-created videos. RESULTS: Most videos were based on personal experience. Half were created by consumers and 34% were ≥ 4.5 min long. Healthcare professional videos were viewed more often( 19400, 59.4% vs 40.8%,P = 0.037, for healthcare professional and consumer, respectively) and more often focused on the purgative type and completing the preparation. Consumer videos received more comments( 10 comments, 62.2% vs 42.7%, P = 0.001) and more often emphasized the palatability of the purgative, disgust, and hunger during the procedure. Content of colonoscopy bowel preparation YouTube? videos is influenced by who creates the video and may affect views on colon cancer screening. CONCLUSION: The impact of perspectives on the quality of health-related information found on the Internet requires further examination.