Shah S G, Brooker J C, Williams C B, Thapar C, Saunders B P
Wolfson Unit for Endocopy, St Mark's Hospital, Harrow, UK.
Lancet. 2000 Nov 18;356(9243):1718-22. doi: 10.1016/S0140-6736(00)03205-0.
Colonoscopy can be technically challenging because of unpredictable colonoscope looping. Without imaging, straightening the colonoscope is sometimes difficult since the endoscopist has to guess where the tip is. Magnetic endoscope imaging (MEI), a new non-radiographical technique for picturing the colonoscope shaft in real time, could facilitate loop straightening and thus improve performance.
We assessed trainees and endoscopists with much experience of routine outpatient colonoscopy. In group 1, trainees examined 113 consecutive patients. MEI views were recorded in all examinations, but procedures were randomised to be done by two trainees, either with the endoscopist and endoscopy assistants viewing the imager display (n=58), or without the imager view (n=55). In group 2, two skilled endoscopists were randomised (as with group 1) to undertake consecutive examinations (n=183) either with (n=92) or without (n=91) the MEI view. MEI views of all procedures were analysed retrospectively.
In both groups, intubation times were shorter (median 11.8 min [4.3-31.5] vs 15.3 min [4-67] [group 1]; 8.0 min [2.6-40.8] vs 9.3 min [2.5-52.6] [group 2]) and number of attempts at straightening the colonoscope fewer (median 5 [0-20] vs 12 [0-57] [group 1]; 7 [0-55] vs 10 [0-80] [group 2]), when the endoscopist was able to see the imager view. In group 1, colonoscopy completion rates were also higher (100% [58] vs 89% [49]) and duration of looping was reduced (median 3 min [0-18.8] vs 5.4 min [0-44.5]) when the imager could be seen. Abdominal hand pressure was more effective when the endoscopist and endoscopy assistant could see the imager view.
MEI significantly improves performance of colonoscopy, particularly when used by trainees, or by experts in technically difficult cases; loops were straightened or controlled effectively, resulting in quick intubation times and high completion rates.
由于结肠镜检查时结肠镜的袢曲情况难以预测，该检查在技术上具有挑战性。在没有成像的情况下，拉直结肠镜有时很困难，因为内镜医师必须猜测镜端的位置。磁性内镜成像（MEI）是一种用于实时显示结肠镜镜身的新型非放射技术，可有助于拉直袢曲，从而提高操作性能。
我们评估了接受培训的人员以及有大量常规门诊结肠镜检查经验的内镜医师。在第1组中，接受培训的人员连续检查了113例患者。所有检查均记录MEI图像，但操作被随机分配给两名接受培训的人员，其中一组（n = 58）是在内镜医师和内镜助手观看成像显示器的情况下进行操作，另一组（n = 55）则不观看成像显示器。在第2组中，两名熟练的内镜医师被随机分组（与第1组相同），连续进行检查（n = 183），一组（n = 92）可以观看MEI图像，另一组（n = 91）则不能。对所有操作的MEI图像进行回顾性分析。
在两组中，当内镜医师能够看到成像显示器时，插管时间均较短（第1组：中位数11.8分钟[4.3 - 31.5] vs 15.3分钟[4 - 67]；第2组：8.0分钟[2.6 - 40.8] vs 9.3分钟[2.5 - 52.6]），拉直结肠镜的尝试次数也较少（第1组：中位数5次[0 - 20] vs 12次[0 - 57]；第2组：7次[0 - 55] vs 10次[0 - 80]）。在第1组中，当可以看到成像显示器时，结肠镜检查的完成率也更高（100%[58例] vs 89%[49例]），袢曲持续时间缩短（中位数3分钟[0 - 18.8] vs 5.4分钟[0 - 44.5]）。当内镜医师和内镜助手能够看到成像显示器时，腹部手压更有效。
MEI显著提高了结肠镜检查的操作性能，尤其是在接受培训的人员使用时，或技术困难病例中由专家使用时；袢曲能够有效拉直或控制，从而实现快速插管时间和高完成率。
