Harewood G C, Mattek N C, Holub J L, Peters D, Lieberman D A
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, USA.
Aliment Pharmacol Ther. 2005 Sep 15;22(6):571-8. doi: 10.1111/j.1365-2036.2005.02632.x.
Terminal ileum intubation rates at colonoscopy are variable. One of the major indications for terminal ileum intubation is to identify Crohn's disease. Signs and symptoms which raise a suspicion of Crohn's include abdominal pain/bloating, anaemia and diarrhoea.
To determine the proportion of terminal ileal intubation in patients undergoing evaluation of abdominal pain/bloating, anaemia or diarrhoea with normal endoscopic findings at colonoscopy.
The Clinical Outcomes Research Initiative national endoscopic database was analysed to determine the proportion of terminal ileum intubation in patients undergoing evaluation of either abdominal pain/bloating, anaemia or diarrhoea with normal endoscopic findings at colonoscopy and to characterize this population of patients. Patients with known or suspected inflammatory bowel disease were excluded from the analysis.
Between January 2000 and December 2003, 21 638 patients underwent complete colonoscopy for evaluation of either abdominal pain/bloating, anaemia or diarrhoea with normal colon findings. Overall, 3858 patients (18%) underwent terminal ileum evaluation. Intubation rates differed according to procedure indication: abdominal pain (13%), anaemia (13%), diarrhoea (28%). Terminal ileum assessment declined with advancing patient age and was least frequent in Black patients (12% vs. 18% in non-Blacks, P < 0.0001). Ileal intubation rates also varied among endoscopy site types: community (17%), academic (21%), Veterans Affairs Medical Centres (17%), P < 0.0001. Multiple logistic regression identified patients with the indication of diarrhoea (OR: 2.58) as more likely to undergo terminal ileum intubation when compared with those with abdominal pain/bloating. Patients in Veterans Affairs (OR: 1.26) and academic (OR: 1.29) sites were more likely to undergo terminal ileum intubation compared with community sites.
Less than one-fifth of patients with either abdominal pain/bloating, anaemia or diarrhoea underwent ileal intubation in the setting of a normal colonoscopy. Significant practice variation was observed in rates of terminal ileum evaluation. Further study is required to determine whether terminal ileum examination impacts patient management or outcome.
结肠镜检查时回肠末端插管率存在差异。回肠末端插管的主要指征之一是识别克罗恩病。引发克罗恩病怀疑的体征和症状包括腹痛/腹胀、贫血和腹泻。
确定在接受结肠镜检查且内镜检查结果正常的腹痛/腹胀、贫血或腹泻患者中回肠末端插管的比例。
分析临床结果研究倡议组织的全国内镜数据库，以确定在接受结肠镜检查且内镜检查结果正常的腹痛/腹胀、贫血或腹泻患者中回肠末端插管的比例，并对这类患者群体进行特征描述。已知或疑似炎症性肠病的患者被排除在分析之外。
在2000年1月至2003年12月期间，21638例患者因腹痛/腹胀、贫血或腹泻且结肠镜检查结果正常而接受了全结肠镜检查。总体而言，3858例患者（18%）接受了回肠末端评估。插管率因检查指征而异：腹痛（13%）、贫血（13%）、腹泻（28%）。回肠末端评估随着患者年龄的增长而下降，在黑人患者中最不常见（12%，非黑人患者为18%，P<0.0001）。回肠插管率在内镜检查地点类型之间也有所不同：社区（17%）、学术机构（21%）、退伍军人事务医疗中心（17%），P<0.0001。多因素逻辑回归分析显示，与腹痛/腹胀患者相比，有腹泻指征的患者（比值比：2.58）更有可能接受回肠末端插管。与社区机构相比，退伍军人事务机构（比值比：1.26）和学术机构（比值比：1.29）的患者更有可能接受回肠末端插管。
在结肠镜检查正常的情况下，腹痛/腹胀、贫血或腹泻患者中接受回肠插管的不到五分之一。回肠末端评估率存在显著的实践差异。需要进一步研究以确定回肠末端检查是否会影响患者管理或治疗结果。
