基于不同肠段的结肠镜检查人群肠道准备失败现状及影响因素分析

目的研究不同肠段发生肠道准备失败的现状, 并分析其影响因素。方法选取2021年12月—2023年1月在北京协和医院消化内镜中心进行结肠镜检查的677例患者作为研究对象, 患者均采用3 L聚乙二醇电解质散分次剂量的标准化肠道准备方案, 以波士顿肠道准备评分量表对患者的肠道准备情况进行评估, 并通过Logistic回归模型分析不同肠段发生肠道准备失败的影响因素。结果结肠镜检查人群的肠道准备不合格率为31.5%(213/677), 在肠道准备失败人群中, 仅近端肠道失败占85.4%(182/213), 全肠道失败占14.1%(30/213), 仅远端肠道失败仅占0.5%(1/213)。将仅远端肠道失败与全肠道失败合并为发生远端肠道准备失败, Logistic回归分析结果显示:男性(P=0.001, OR=2.253, 95%CI:1.399～3.629)、门诊患者(P<0.001, OR=4.175, 95%CI:2.410～7.231)、无结直肠癌家族史(P=0.001, OR=2.117, 95%CI:1.365～3.284)以及因诊断行结肠镜检查(P=0.003, OR=1.97...     

基于列线图可视化评估结肠镜肠道准备充分度的研究

目的探讨结肠镜检查前根据肠道准备情况建立列线图, 评价肠道准备充分度并指导临床决策的可行性。方法选取2020年9月—2021年3月在中南大学湘雅医院消化内镜中心行结肠镜诊疗的受检者, 进行问卷调查, 最终回收有效问卷1 023份, 问卷内容主要包括受检者的临床特征、排便习惯、服药后排便次数和末次排便时间及检查前肠道准备自评结果, 采用单盲法并指定同一位内镜医师对受检者肠道准备情况进行波士顿肠道准备量表(Boston bowel preparation scale, BBPS)评分, 运用多因素分析探究肠道准备充分度的影响因素, 根据影响因素绘制列线图, 评估肠道准备充分度。结果根据BBPS评分, 674例受检者肠道准备充分, 349例受检者肠道准备不充分。多因素分析发现每周排便次数(OR=1.649, 95%CI:1.233～2.204, P=0.001)、服药后排便次数(OR=3.963, 95%CI:1.851～8.485, P<0.001)、服药后末次排便时间(OR=5.151, 95%CI:1.152～23.037, P=0.032)、检查前肠道准备自我评估(OR=8.2...     

Polyp detection on video colonoscopy using a hybrid 2D/3D CNN

Colonoscopy is the gold standard for early diagnosis and pre-emptive treatment of colorectal cancer by detecting and removing colonic polyps. Deep learning approaches to polyp detection have shown potential for enhancing polyp detection rates. However, the majority of these systems are developed and evaluated on static images from colonoscopies, whilst in clinical practice the treatment is performed on a real-time video feed. Non-curated video data remains a challenge, as it contains low-quality frames when compared to still, selected images often obtained from diagnostic records. Nevertheless, it also embeds temporal information that can be exploited to increase predictions stability. A hybrid 2D/3D convolutional neural network architecture for polyp segmentation is presented in this paper. The network is used to improve polyp detection by encompassing spatial and temporal correlation of the predictions while preserving real-time detections. Extensive experiments show that the hybrid method outperforms a 2D baseline. The proposed architecture is validated on videos from 46 patients and on the publicly available SUN polyp database. A higher performance and increased generalisability indicate that real-world clinical implementations of automated polyp detection can benefit from the hybrid algorithm and the inclusion of temporal information.     

结肠镜检查前肠道准备质量的研究进展

结肠镜是目前筛查、诊断及治疗结直肠相关疾病的重要手段,而肠道准备质量直接关系到结肠镜的实施效果及患者的复检意愿,充分的肠道准备不仅能缩短操作时间、减轻患者不适,更能提高结肠相关疾病的检出率及疗效。因此,提高结肠镜前肠道准备质量至关重要。本文将介绍影响肠道准备质量的主要因素及目前常见的肠道准备方法,并就如何提高肠道准备质量进行综述。     

Iron deficiency: From diagnosis to treatment

Iron deficiency is the most frequent cause of anaemia worldwide. It impairs quality of life, increases asthenia and can lead to clinical worsening of patients. In addition, iron deficiency has a complex mechanism whose pathologic pathway is recently becoming better understood. The discovery of hepcidin has allowed a better clarification of iron metabolism regulation. Furthermore, the ratio of concentration of soluble transferrin receptor to the log of the ferritin level, has been developed as a tool to detect iron deficiency in most situations. The cause of iron deficiency should always be sought because the underlying condition can be serious. This review will summarize the current knowledge regarding diagnostic algorithms for iron deficiency anaemia. The majority of aetiologies occur in the digestive tract, in men and postmenopausal women, and justify morphological examination of the gut. First line investigations are upper gastrointestinal endoscopy and colonoscopy, and when negative, the small bowel should be explored; newer tools such as video capsule endoscopy have also been developed. The treatment of iron deficiency is aetiological if possible and iron supplementation whether in oral or in parenteral form. New parenteral formulations are available and seem to have promising results in terms of efficacy and safety.