Fasoli R, Repaci G, Comin U, Minoli G
Gastroenterology and Digestive Endoscopy Service, II Division of Medicine, Magenta Hospital, Magenta, MI, Italy.
Dig Liver Dis. 2002 Dec;34(12):833-41. doi: 10.1016/s1590-8658(02)80252-3.
To record prospectively, in a multi-centre survey, the adherence to some quality parameters of lower digestive endoscopy in everyday practice, focusing in particular on sedation and monitoring; choice of extension of endoscopic examination by the operator and relative performance in intubation of the caecum; behaviour, in some particular clinical circumstances, such as fresh haematochezia, screening and surveillance situations, functional symptoms, management of polyps.
Twenty-five centres located in Lombardia, Italy took part in the study; the duration of the survey was 2 weeks. 1,406 consecutive cases were recorded.
The main indications to colonoscopy were fresh haematochezia (21%). abdominal pain (11.7%) and surveillance after surgery for tumours or endoscopic polyp removal (24.3%). Screening examinations accounted for 7.1% of all examinations. Conscious sedation was administered in 63.9% of patients; pulse oxymetry and cardiac frequency monitoring was used in 44.2% of cases. Total colonoscopy was planned in 84.2% of cases; the actual rate of intubation of the caecum in the cases submitted to the procedure was 84.1%. Normal results were obtained in 24.3%. In 24.3% of patients, one or more polyps were identified; 84.2% of these were removed during the first examination. Four complications (accounting for 0.28% of cases) were recorded, all after polypectomy and all successfully treated conservetively.
The present study has shown that some attitudes in lower digestive endoscopy are sub-optimal: in particular, screening examinations are still infrequent; conscious sedation and monitoring have probably been used too rarely; intubation of the caecum was achieved in <90% of cases; the endoscopic removal of many polyps has been delayed for unexplained reasons. On the other hand, timing of surveillance after surgery for tumours or endoscopic removal of polyps has, overall, been adequate; the rate of normal examinations and the rate of complications have been satisfactorily low.
在一项多中心调查中前瞻性记录日常实践中低位消化内镜检查某些质量参数的依从情况，尤其关注镇静与监测；操作者对内镜检查范围的选择及盲肠插管的相关表现；在一些特殊临床情况（如新鲜便血、筛查与监测情况、功能性症状、息肉处理）下的行为。
意大利伦巴第地区的25个中心参与了本研究；调查持续时间为2周。记录了1406例连续病例。
结肠镜检查的主要适应证为新鲜便血（21%）、腹痛（11.7%）以及肿瘤手术后或内镜下息肉切除后的监测（24.3%）。筛查检查占所有检查的7.1%。63.9%的患者接受了清醒镇静；44.2%的病例使用了脉搏血氧饱和度和心率监测。84.2%的病例计划进行全结肠镜检查；接受该操作的病例中实际盲肠插管率为84.1%。正常结果占24.3%。24.3%的患者发现了一个或多个息肉；其中84.2%在首次检查时被切除。记录到4例并发症（占病例的0.28%），均发生在息肉切除术后，且均经保守治疗成功。
本研究表明低位消化内镜检查中的一些做法并非最佳：特别是，筛查检查仍然较少；清醒镇静和监测的使用可能过少；不到90%的病例实现了盲肠插管；许多息肉的内镜切除因不明原因而延迟。另一方面，肿瘤手术后或内镜下息肉切除后的监测时机总体上是合适的；正常检查率和并发症发生率令人满意地低。
