Gidwani A L, Makar R, Garrett D, Gilliland R
Department of Surgery, Altnagelvin Area Hospital, Londonderry, Northern Ireland, United Kingdom.
Surg Endosc. 2007 Jun;21(6):945-9. doi: 10.1007/s00464-006-9111-x. Epub 2006 Dec 6.
Preparation for outpatient flexible sigmoidoscopy using a self-administered phosphate enema is the standard practice in our unit, but it provides acceptable bowel preparation in only 80% of patients. This study compared two methods of bowel preparation with the current standard in an attempt to improve efficacy and acceptability.
From January to September 2003, patients scheduled for out-patient flexible sigmoidoscopy were prospectively randomized to 3 groups: group 1: one Fleet enema 2 h pre-procedure; group 2: two Fleet enemas, one on the evening prior to sigmoidoscopy and one 2 h pre-procedure; group 3: lactulose 30 ml orally 48 and 24 h prior to sigmoidoscopy, plus a single Fleet enema 2 h pre-procedure. A patient questionnaire was used to assess side effects and tolerance. The endoscopists questionnaire assessed the indication for the procedure, quality of preparation, depth of insertion, and pathological findings identified. Power calculations were based on the 80% acceptable preparation rate obtained using a single enema.
For this study, 305 patients were randomized to the three groups. Patient data were available for 261 patients (group 1 = 105; group 2 = 81; group 3 = 75), and endoscopist data were available for 251 patients (group 1 = 97; group 2 = 79; group 3 = 75). No difference was noted between the groups with regard to age, gender, procedure indication, grade of endoscopist, or patient acceptability variables (ease of use: p = 0.09; assistance required: p = 0.11; cramps experienced: p = 0.84; alternative method: p = 0.25). There was no significant difference between the groups in terms of depth of insertion (p = 0.42-chi-squared test) or abnormalities noted (p = 0.34-chi-squared test). Nor was there any difference in the quality of preparation of patients in group 1 versus group 2 (p = 0.39-Fishers exact test) or group 1 versus group 3 (p = 0.13-Fishers exact). However, lactulose + Fleet resulted in significantly fewer patients with acceptable preparation compared with those who administered two Fleet enemas (p = 0.02- Fishers exact test).
The addition of a Fleet enema or oral lactulose over and above a single Fleet enema gives no significant improvement in the acceptability or efficacy of bowel preparation.
在我们科室，使用自行给药的磷酸盐灌肠剂为门诊患者做乙状结肠镜检查准备是标准做法，但仅80%的患者能获得可接受的肠道准备效果。本研究比较了两种肠道准备方法与现行标准方法，以提高效果和可接受性。
2003年1月至9月，将计划进行门诊乙状结肠镜检查的患者前瞻性随机分为3组：第1组：检查前2小时使用一支Fleet灌肠剂；第2组：乙状结肠镜检查前一晚及检查前2小时各使用一支Fleet灌肠剂；第3组：乙状结肠镜检查前48小时和24小时口服30ml乳果糖，外加检查前2小时使用一支Fleet灌肠剂。使用患者问卷评估副作用和耐受性。内镜医师问卷评估检查指征、准备质量、插入深度及发现的病理结果。功效计算基于使用单次灌肠剂获得的80%可接受准备率。
本研究中，305例患者被随机分入3组。261例患者有可用的患者数据（第1组 = 105例；第2组 = 81例；第3组 = 75例），251例患者有可用的内镜医师数据（第1组 = 97例；第2组 = 79例；第3组 = 75例）。各组在年龄、性别、检查指征、内镜医师级别或患者可接受性变量（易用性：p = 0.09；所需协助：p = 0.11；经历的痉挛：p = 0.84；替代方法：p = 0.25）方面无差异。各组在插入深度（p = 0.42 - 卡方检验）或发现的异常（p = 0.34 - 卡方检验）方面无显著差异。第1组与第2组患者的准备质量（p = 0.39 - Fisher精确检验）或第1组与第3组患者的准备质量（p = 0.13 - Fisher精确检验）也无差异。然而，与使用两支Fleet灌肠剂的患者相比，乳果糖 + Fleet灌肠剂组准备可接受的患者明显更少（p = 0.02 - Fisher精确检验）。
在单次Fleet灌肠剂基础上额外添加一支Fleet灌肠剂或口服乳果糖，在肠道准备的可接受性或效果方面并无显著改善。
