Park Chang-Hwan, Lee Wan-Sik, Joo Young-Eun, Kim Hyun-Soo, Choi Sung-Kyu, Rew Jong-Sun, Kim Sei-Jong
Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea.
Am J Gastroenterol. 2006 Nov;101(11):2504-10. doi: 10.1111/j.1572-0241.2006.00790.x.
Small-caliber upper endoscopes can be used safely and effectively for sedation-free colonoscopy. The objective of the study is to assess the efficacy of a small-caliber upper endoscope (9.2 mm) comparing with a standard colonoscope (12.2 mm).
In a prospective trial, patients undergoing sedation-free colonoscopy were randomly assigned to the upper endoscope (E) or the standard colonoscope (C). Outcome measures included patient self-assessed pain score (4-point scale), endoscopist-assessed pain score (4-point scale), cecal intubation rate, difficult cecal intubation rate (>900 s), number of polyps detected, and complication rates.
A total of 244 patients were entered. Clinical characteristics were not different between the two groups. Cecal intubation was achieved in 91.0% of the patients in each group. The mean patient self-assessed pain score (SD) was significantly lower in the E group compared with the C group: 1.44 (0.81) versus 2.08 (1.10), p < 0.001. The mean endoscopist assessment of patient pain score (SD) was significantly lower in the E group compared with the C group as well: 1.27 (0.67) versus 1.58 (0.90), p= 0.003. In patients with low body mass index (BMI < 22 kg/m(2)), the cecal intubation rate was significantly higher in the E group (97.7%vs 79.4%, p= 0.026) and the difficult cecal intubation rate was significantly lower in the E group (9.3%vs 32.4%, p= 0.011). There were no significant differences in the number of polyps detected and complication rates between the two groups.
A small-caliber upper endoscope is tolerable and effective for sedation-free colonoscopy, especially in patients with low BMI.
小口径上消化道内窥镜可安全有效地用于无镇静结肠镜检查。本研究的目的是评估小口径上消化道内窥镜（9.2毫米）与标准结肠镜（12.2毫米）相比的疗效。
在一项前瞻性试验中，接受无镇静结肠镜检查的患者被随机分配至使用上消化道内窥镜组（E组）或标准结肠镜组（C组）。观察指标包括患者自我评估的疼痛评分（4分制）、内镜医师评估的疼痛评分（4分制）、盲肠插管率、困难盲肠插管率（>900秒）、检测到的息肉数量以及并发症发生率。
共纳入244例患者。两组的临床特征无差异。每组91.0%的患者完成了盲肠插管。E组患者自我评估的平均疼痛评分（标准差）显著低于C组：1.44（0.81）对2.08（1.10），p<0.001。E组内镜医师对患者疼痛评分的平均评估（标准差）也显著低于C组：1.27（0.67）对1.58（0.90），p = 0.003。在低体重指数（BMI<22kg/m²）的患者中，E组的盲肠插管率显著更高（97.7%对79.4%，p = 0.026），E组的困难盲肠插管率显著更低（9.3%对32.4%，p = 0.011）。两组在检测到的息肉数量和并发症发生率方面无显著差异。
小口径上消化道内窥镜用于无镇静结肠镜检查是可耐受且有效的，尤其是在低BMI患者中。
