Harrison Matthew, Singh Navjot, Rex Douglas K
Indiana University Hospital, 550 University Boulevard, Indianapolis, Indiana 46202, USA.
Am J Gastroenterol. 2004 Mar;99(3):519-22. doi: 10.1111/j.1572-0241.2004.04070.x.
Small adenomas are commonly missed during routine colonoscopy. The aim of this study was to determine whether routine retroflexion in the proximal colon would improve adenoma detection rates.
One hundred patients underwent colonoscopy from the cecum to the splenic flexure by a gastroenterology fellow, with the removal of all visualized polyps. The cecum was then reintubated and patients were randomized to a second exam of the proximal colon by an experienced staff physician in either the forward view or a retroflexed view.
Two patients were excluded due to a difficult initial cecal intubation. Forty-eight patients were randomized to forward view and 50 patients were randomized to a retroflexed view. Retroflexion was successful in the cecum in 60%, the ascending colon 100%, and the transverse colon 98%. The success in retroflexion was determined in part by the type of colonoscope used. If any portion of the retroflexed examination could not be performed, that reexamination was performed in the forward view. The calculated miss rates for all polyps and adenomas among patients randomized to second examination in the forward view was 36.8% and 33.3%, respectively. The calculated miss rate for all polyps and for adenomas among patients randomized to a second examination in the retroflexed view was 38.1% and 23.7%, respectively. There was no difference in miss rates for all polyps or for adenomas (p= 0.31) when the second examination was performed in the forward view versus retroflexed view.
A second examination by retroflexion in the proximal colon did not increase the calculated miss rate relative to that performed by a forward view examination. These results do not support the addition of routine right colon retroflexion to colonoscopy.
在常规结肠镜检查过程中，小腺瘤常被漏诊。本研究旨在确定在近端结肠进行常规反转检查是否能提高腺瘤检出率。
100例患者由一名胃肠病学住院医师从盲肠至脾曲进行结肠镜检查，并切除所有可见息肉。然后重新插入盲肠，患者被随机分为由一名经验丰富的主治医师进行近端结肠的第二次检查，检查方式为直视或反转观察。
2例患者因初次盲肠插管困难而被排除。48例患者被随机分入直视组，50例患者被随机分入反转观察组。反转检查在盲肠的成功率为60%，升结肠为100%，横结肠为98%。反转检查的成功部分取决于所用结肠镜的类型。如果反转检查的任何部分无法进行，则该重新检查采用直视方式进行。随机分入第二次检查采用直视方式的患者中，所有息肉和腺瘤的漏诊率分别计算为36.8%和33.3%。随机分入第二次检查采用反转观察方式的患者中，所有息肉和腺瘤的漏诊率分别计算为38.1%和23.7%。第二次检查采用直视方式与反转观察方式时，所有息肉或腺瘤的漏诊率无差异（p = 0.31）。
相对于直视检查，在近端结肠进行反转的第二次检查并未增加计算得出的漏诊率。这些结果不支持在结肠镜检查中增加常规右半结肠反转检查。
