Wehrmann Till, Lechowicz Izabel, Martchenko Ksenia, Riphaus Andrea
Department of Internal Medicine I (Gastroenterology, Hepatology & Interventional Endoscopy), Krankenhaus Siloah, Klinikum Region Hannover GmbH, Roesebeckstr. 15, 30449 Hannover, Germany.
Int J Colorectal Dis. 2008 Apr;23(4):443-6. doi: 10.1007/s00384-007-0415-7.
Colorectal cancer screening increased the workload of colonoscopic procedures in endoscopic units. Recent developments advocated the use of smaller and more flexible scopes to achieve the goal of a complete examination to the cecum. Therefore, the use of an upper GI scope for colonoscopy can be considered.
Six-hundred and fifty consecutive patients (age, 64 +/- 20 years, 395 women) undergoing routine colonoscopy were examined with either a standard colonoscope or an upper GI scope in randomized order. In case of an incomplete examination, colonoscopy was repeated with the alternative instrument in the same session. All patients underwent bowel preparation with 4 1 of a polyethylene glycol solution, and the examinations were performed under conscious sedation (midazolam and pethidine i.v.) by a single investigator.
Because of insufficient colonic preparation or refusal to participate, 28 patients had to be excluded. Both groups (colonoscope group, n = 315, upper GI scope group, n = 307) were well comparable with respect to their demographic data, previous abdominal surgery, the presence of diverticulosis, and the number of former colonoscopic examinations, respectively. Successful cecum intubation was achieved in 96% of the cases in the colonoscope group and in 93% of the patients from the upper GI scope group (p = 0.82). However, the time until the cecum was reached was prolonged to 8.7 +/- 2.4 min when using the upper GI scope compared with 8.2 +/- 2.3 min in the colonoscope group (p = 0.006). In the colonoscope group, a switch to the upper GI scope enables a complete colonoscopy in all but three cases (11/14, 79%) whereas this aim was only achieved vice versa in the upper GI scope group (using a colonoscope) in 7 of 21 patients (33%, p = 0.04).
Routine colonoscopy can be performed effectively with standard upper GI scopes in a western population if no colonoscope is available.
结直肠癌筛查增加了内镜科室结肠镜检查的工作量。最近的进展提倡使用更小、更灵活的内镜，以实现对盲肠进行全面检查的目标。因此，可以考虑使用上消化道内镜进行结肠镜检查。
650例连续接受常规结肠镜检查的患者（年龄64±20岁，女性395例），随机顺序使用标准结肠镜或上消化道内镜进行检查。若检查不完全，则在同一次检查中用另一种器械重复结肠镜检查。所有患者均用4升聚乙二醇溶液进行肠道准备，检查由一名研究者在清醒镇静（静脉注射咪达唑仑和哌替啶）下进行。
由于结肠准备不足或拒绝参与，28例患者被排除。两组（结肠镜组，n = 315；上消化道内镜组，n = 307）在人口统计学数据、既往腹部手术史、憩室病的存在情况以及既往结肠镜检查次数方面分别具有良好的可比性。结肠镜组96%的病例成功插入盲肠，上消化道内镜组93%的患者成功插入盲肠（p = 0.82）。然而，使用上消化道内镜到达盲肠的时间延长至8.7±2.4分钟，而结肠镜组为8.2±2.3分钟（p = 0.006）。在结肠镜组中，除3例（11/14，79%）外，改用另一种器械均能完成全结肠镜检查，而在上消化道内镜组中，只有7例（21例中的33%，p = 0.04）改用结肠镜才能达到这一目的。
在西方人群中，如果没有结肠镜，使用标准上消化道内镜可有效地进行常规结肠镜检查。
