Stevenson G W, Norman G, Frost R, Somers S
Department of Radiology, McMaster University, Hamilton, Ontario, Canada.
Clin Radiol. 1991 Nov;44(5):317-21. doi: 10.1016/s0009-9260(05)81266-8.
This study examines the preference of 64 out-patients for either a barium meal or an upper gastrointestinal endoscopy. The sequence of the examinations was randomized to avoid order bias. An initial preference for a barium meal of almost two-to-one, with 53% having no preference, was changed after the investigations to a preference for endoscopy of two-to-one with 5% having no preference. The use of mild sedation and the skill of the endoscopist had a major impact on the patients' opinion of the endoscopic procedure, and on their choice of examination for any repeat study. There was little agreement between clinical diagnosis and the result of investigation, but clinicians tended to accept the reported result of the investigation, especially if the result was abnormal. Despite a change in diagnosis in 34 of 49 patients there was little change in management as a result of the investigations, supporting the view that young patients with dyspepsia may be managed with symptomatic treatment initially, and without investigation. This study lends further support to the view that endoscopy should be the investigation of choice in patients with persistent dyspepsia, especially those whose age or infirmity may make barium examination suboptimal.
本研究调查了64名门诊患者对钡餐检查或上消化道内镜检查的偏好。检查顺序随机安排以避免顺序偏倚。最初，几乎三分之二的患者偏好钡餐检查，53%的患者无偏好，但在检查后，偏好内镜检查与偏好钡餐检查的比例变为二比一，5%的患者无偏好。使用轻度镇静以及内镜医师的技术对患者对内镜检查的看法及其对任何重复检查的选择产生了重大影响。临床诊断与检查结果之间几乎没有一致性，但临床医生倾向于接受所报告的检查结果，尤其是当结果异常时。尽管49名患者中有34名的诊断发生了变化，但检查结果对治疗管理几乎没有影响，这支持了以下观点：消化不良的年轻患者最初可以进行对症治疗，而无需进行检查。这项研究进一步支持了以下观点：对于持续性消化不良患者，尤其是那些年龄或身体状况可能使钡餐检查效果不佳的患者，内镜检查应作为首选的检查方法。
