结肠镜退镜时动态改变患者体位可增加腺瘤检出率：一项随机交叉试验。
Dynamic patient position changes during colonoscope withdrawal increase adenoma detection: a randomized, crossover trial.
机构信息
Wolfson Unit for Endoscopy, St. Mark’s Hospital, Imperial College London, London.
出版信息
Gastrointest Endosc. 2011 Mar;73(3):456-63. doi: 10.1016/j.gie.2010.07.046. Epub 2010 Oct 15.
BACKGROUND
Colonoscopy has a miss rate for adenomas that may partly relate to poor visualization of the colonic surface. Dynamic position changes during colonoscope withdrawal can improve luminal distension.
OBJECTIVE
To assess whether position changes also improve adenoma and polyp detection.
DESIGN
Randomized crossover clinical trial.
SETTING
Academic endoscopy unit.
PATIENTS
This study involved 130 patients who presented for routine colonoscopy.
INTERVENTION
Examination either entirely in the left lateral position followed by position changes (cecum to hepatic flexure, left lateral; transverse colon, supine; splenic flexure and descending colon, right lateral) or vice versa. After both examinations, polyps were removed for histopathology.
MAIN OUTCOME MEASUREMENTS
Proportion of patients with ≥1 polyp or adenoma detected between the hepatic flexure and the sigmoid-descending colon junction. Luminal distension was measured on a scale of 1 to 5: 1, total collapse; 5, fully distended.
RESULTS
At least 1 adenoma was detected in 34% of patients in colon areas in which the patient position differed from left lateral (transverse colon, splenic flexure, descending colon) compared with 23% examined with the patient in the left lateral position alone (P = .01). At least 1 polyp was detected in 52% of patients with position changes versus 34% of patients examined in the left lateral position alone (P < .001). Adenoma and polyp detection were positively correlated with an improved distension score (correlation coefficient, 0.12; P < .001). Adenomas were detected in 16% of colon areas with adequate distension scores (4 and 5) compared with 7% of those with borderline or nondiagnostic scores (1-3; P < .001).
LIMITATIONS
Single-operator study.
CONCLUSION
Dynamic position changes during colonoscope withdrawal significantly improved polyp and adenoma detection. (
CLINICAL TRIAL REGISTRATION NUMBER
NCT00234650).
背景
结肠镜检查对腺瘤的漏诊率可能部分与结肠表面显示不佳有关。在结肠镜退镜过程中动态改变体位可以改善肠腔扩张。
目的
评估体位改变是否也能提高腺瘤和息肉的检出率。
设计
随机交叉临床试验。
地点
学术内镜单位。
患者
这项研究涉及 130 名因常规结肠镜检查而就诊的患者。
干预
检查完全在左侧卧位进行，然后进行体位改变（盲肠至肝曲，左侧；横结肠，仰卧位；脾曲和降结肠，右侧）或反之亦然。两次检查后，均切除息肉进行组织病理学检查。
主要观察指标
肝曲至乙状结肠-降结肠交界处至少有 1 个息肉或腺瘤的患者比例。肠腔扩张程度采用 1 至 5 分制进行评估：1，完全塌陷；5，完全扩张。
结果
在与患者左侧卧位（横结肠、脾曲、降结肠）不同的体位下，至少有 1 个腺瘤在结肠区域被检出的患者比例为 34%，而单独采用左侧卧位检查的患者比例为 23%（P =.01）。体位改变的患者中至少有 1 个息肉的检出率为 52%，而单独采用左侧卧位检查的患者为 34%（P <.001）。腺瘤和息肉的检出与改善的扩张评分呈正相关（相关系数为 0.12；P <.001）。在扩张评分 4 分和 5 分（充盈良好）的结肠区域，腺瘤检出率为 16%，而在扩张评分 1 分至 3 分（临界或不可诊断）的结肠区域，腺瘤检出率为 7%（P <.001）。
局限性
单操作员研究。
结论
在结肠镜退镜过程中动态改变体位可显著提高息肉和腺瘤的检出率。（临床试验注册号：NCT00234650）。
Zotero 插件