Fritscher-Ravens A, Fox S, Swain C P, Milla P, Long G
Homerton University Hospital, London, UK.
Endoscopy. 2006 Mar;38(3):209-13. doi: 10.1055/s-2006-925138.
Conventional colonoscopy as the gold standard for large-bowel diagnostics and therapy may fail in 5 %-20 % of cases, depending on the experience of the examiner. Colonoscopy is regarded as difficult and painful by many patients. In an attempt to overcome the limitations of conventional colonoscopes, a guide wire-directed, thin, flexible diagnostic colonoscope, the CathCam was developed. In this prospective pilot study, we report its use in patients in whom conventional colonoscopy had failed.
49 patients with a previous or current failure of complete colonoscopy were invited to participate in a trial using the new CathCam system, and 14 (nine men; mean age 59 years) accepted. The CathCam is an 11-mm diameter disposable, multilumen catheter, with visualization by a 3-mm camera with six light-emitting diodes. In the first five patients, the CathCam was inserted over a newly developed 0.024-inch, hinged, lumen-seeking guide wire. Subsequently, a modified combined approach was used: a conventional colonoscope was introduced into the sigmoid or left colon, then the guide wire was advanced as far as possible, followed by CathCam insertion over it. Caecal intubation rate, insertion times and patient discomfort were recorded; patients received low-dose midazolam sedation (2-5 mg).
One patient was excluded during colonoscopy. The caecum could be eventually reached in 12 of 13 patients; in the remaining patient a significant sigmoid stricture could be passed, but further advancement appeared too risky. The mean caecal intubation time was 24 minutes (range 3-105 min). Only two patients experienced pain and discomfort during the procedure (one immediate assessment and one case reported at later telephone interview). No complications occurred, and previously undiagnosed important findings were obtained in 9 cases.
A combined approach, consisting of guide wire insertion via a partially introduced colonoscope followed by CathCam or colonoscope insertion into the caecum was successful in over 90 % of patients with previous failure of complete colonoscopy. Further improvements may make this system suitable for use as a standard diagnostic colonoscope, either as a single unit (CathCam plus guide wire) or using the guide wire alone with a standard colonoscope in difficult cases.
传统结肠镜检查作为大肠诊断和治疗的金标准，根据检查者的经验，在5%-20%的病例中可能会失败。许多患者认为结肠镜检查既困难又痛苦。为了克服传统结肠镜的局限性，研发了一种导丝引导的、纤细灵活的诊断性结肠镜——CathCam。在这项前瞻性试点研究中，我们报告了其在传统结肠镜检查失败的患者中的应用情况。
邀请49例既往或当前完全结肠镜检查失败的患者参与使用新型CathCam系统的试验，14例（9名男性；平均年龄59岁）接受了试验。CathCam是一种直径11毫米的一次性多腔导管，通过带有六个发光二极管的3毫米摄像头进行可视化。在前五例患者中，CathCam通过一根新研发的0.024英寸铰接式寻腔导丝插入。随后，采用了改良的联合方法：将传统结肠镜插入乙状结肠或左半结肠，然后尽可能推进导丝，接着将CathCam沿导丝插入。记录盲肠插管率、插入时间和患者不适情况；患者接受低剂量咪达唑仑镇静（2-5毫克）。
结肠镜检查期间排除1例患者。13例患者中有12例最终到达了盲肠；在其余1例患者中，乙状结肠严重狭窄可以通过，但进一步推进似乎风险太大。平均盲肠插管时间为24分钟（范围3-105分钟）。只有2例患者在操作过程中经历了疼痛和不适（1例即时评估，1例在后续电话随访中报告）。未发生并发症，9例患者获得了先前未诊断出的重要发现。
对于既往完全结肠镜检查失败的患者，超过90%的患者采用联合方法成功，即先通过部分插入的结肠镜插入导丝，然后插入CathCam或结肠镜至盲肠。进一步改进可能使该系统适合用作标准诊断结肠镜，既可以作为一个整体（CathCam加导丝）使用，也可以在困难病例中单独使用导丝与标准结肠镜配合使用。
