Jechart G, Messmann Helmut
Department of Medicine, Division of Gastroenterology, Klinikum Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany.
Best Pract Res Clin Gastroenterol. 2008;22(5):777-88. doi: 10.1016/j.bpg.2008.06.001.
The search for inflammatory and neoplastic lesions are the main indications for colonoscopy. A high rate of detection of polyps has become a quality criterion that depends on skilled handling of the colonoscope, on expertise and concentration during the examination, on excellent bowel preparation, and on a high standard of technical equipment. The diagnostic benefits outweigh the risk of bleeding, perforation and infection in almost all situations. Contraindications are signs of perforated intestine or imminent perforation due to deep ulcerations, necroses, or fulminant colitis. The patient's comorbidity must be considered to assess the physical stress of bowel preparation, colonoscopy and sedation. Informed consent is necessary and must be documented in all cases. It is advisable to explain planned therapeutic manoeuvres before the examination, since all non-invasive polyps must be removed completely. Total colonoscopy is possible in 95-99% of cases, but technical efforts are under way to solve the problem of looping and fixed colon angulations. Optimising optical imaging is another main focus of industrial development. The combination of narrow-band imaging, zoom magnification, and high-definition processor technology is currently the most promising tool for identifying small and flat lesions in the colon.
寻找炎症性和肿瘤性病变是结肠镜检查的主要指征。息肉的高检出率已成为一项质量标准，这取决于结肠镜的熟练操作、检查过程中的专业知识和专注度、良好的肠道准备以及高标准的技术设备。在几乎所有情况下，诊断益处都超过出血、穿孔和感染的风险。禁忌证为肠穿孔迹象或因深部溃疡、坏死或暴发性结肠炎导致的即将穿孔。必须考虑患者的合并症，以评估肠道准备、结肠镜检查和镇静带来的身体应激。知情同意是必要的，且在所有情况下都必须记录在案。建议在检查前解释计划中的治疗操作，因为所有非侵入性息肉都必须完全切除。95% - 99%的病例可以进行全结肠镜检查，但目前正在努力解决肠襻和结肠固定角度的问题。优化光学成像也是产业发展的另一个主要重点。窄带成像、变焦放大和高清处理器技术的结合目前是识别结肠小而扁平病变最有前景的工具。
