Froehlich Florian, Wietlisbach Vincent, Gonvers Jean-Jacques, Burnand Bernard, Vader John-Paul
Department of Gastroenterology PMU/CHUV, Institute of Social and Preventive Medicine, University of Lausanne, Rue du Bugnon 44, CH-1011 Lausanne, Switzerland.
Gastrointest Endosc. 2005 Mar;61(3):378-84. doi: 10.1016/s0016-5107(04)02776-2.
The quality of colon cleansing is a major determinant of quality of colonoscopy. To our knowledge, the impact of bowel preparation on the quality of colonoscopy has not been assessed prospectively in a large multicenter study. Therefore, this study assessed the factors that determine colon-cleansing quality and the impact of cleansing quality on the technical performance and diagnostic yield of colonoscopy.
Twenty-one centers from 11 countries participated in this prospective observational study. Colon-cleansing quality was assessed on a 5-point scale and was categorized on 3 levels. The clinical indication for colonoscopy, diagnoses, and technical parameters related to colonoscopy were recorded.
A total of 5832 patients were included in the study (48.7% men, mean age 57.6 [15.9] years). Cleansing quality was lower in elderly patients and in patients in the hospital. Procedures in poorly prepared patients were longer, more difficult, and more often incomplete. The detection of polyps of any size depended on cleansing quality: odds ratio (OR) 1.73: 95% confidence interval (CI)[1.28, 2.36] for intermediate-quality compared with low-quality preparation; and OR 1.46: 95% CI[1.11, 1.93] for high-quality compared with low-quality preparation. For polyps >10 mm in size, corresponding ORs were 1.0 for low-quality cleansing, OR 1.83: 95% CI[1.11, 3.05] for intermediate-quality cleansing, and OR 1.72: 95% CI[1.11, 2.67] for high-quality cleansing. Cancers were not detected less frequently in the case of poor preparation.
Cleansing quality critically determines quality, difficulty, speed, and completeness of colonoscopy, and is lower in hospitalized patients and patients with higher levels of comorbid conditions. The proportion of patients who undergo polypectomy increases with higher cleansing quality, whereas colon cancer detection does not seem to critically depend on the quality of bowel preparation.
结肠清洁质量是结肠镜检查质量的主要决定因素。据我们所知，尚未在大型多中心研究中对肠道准备对结肠镜检查质量的影响进行前瞻性评估。因此，本研究评估了决定结肠清洁质量的因素以及清洁质量对结肠镜检查技术操作和诊断率的影响。
来自11个国家的21个中心参与了这项前瞻性观察研究。结肠清洁质量采用5分制进行评估，并分为3个等级。记录结肠镜检查的临床指征、诊断结果以及与结肠镜检查相关的技术参数。
本研究共纳入5832例患者（男性占48.7%，平均年龄57.6[15.9]岁）。老年患者和住院患者的清洁质量较低。准备不佳的患者进行结肠镜检查的时间更长、难度更大，且更常不完整。任何大小息肉的检出都取决于清洁质量：中等质量准备与低质量准备相比，优势比（OR）为1.73：95%置信区间（CI）[1.28，2.36]；高质量准备与低质量准备相比，OR为1.46：95%CI[1.11，1.93]。对于直径>10mm的息肉，低质量清洁的相应OR为1.0，中等质量清洁的OR为1.83：95%CI[1.11，3.05]，高质量清洁的OR为1.72：95%CI[1.11，2.67]。准备不佳时癌症的检出频率并未降低。
清洁质量是结肠镜检查质量、难度、速度和完整性的关键决定因素，住院患者和合并症较多的患者清洁质量较低。息肉切除术患者的比例随着清洁质量的提高而增加，而结肠癌的检测似乎并不严重依赖于肠道准备的质量。
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