Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Taoyuan, Taiwan.
J Gastroenterol Hepatol. 2012 Jan;27(1):76-80. doi: 10.1111/j.1440-1746.2011.06795.x.
The technical performance of colonoscopy performed in deeply sedated patients differs from that performed without sedation or under minimal to moderate sedation. The aim of this study is to evaluate the factors affecting cecal intubation during colonoscopy performed under deep sedation.
A total of 5352 consecutive subjects who underwent a screening colonoscopy as part of a health check-up between January 2008 and December 2008 at an academic hospital were reviewed. All endoscopies were performed with deep sedation using combination propofol or propofol alone. Data collected included characteristics of the patients (age, gender, body mass index, bowel habits, history of abdominal or pelvic surgery, quality of bowel preparation, and presence/absence of colonic diverticula) and characteristics of the colonoscopists (experience level, colonoscopy procedure volume, and instrument handling method). These factors were analyzed to evaluate their impact on cecal intubation rates.
The crude cecal intubation rate was 98% and the adjusted cecal intubation rate was 98.3%. The mean cecal intubation time was 5.6 ± 3.2 min. Multivariate logistic regression analysis demonstrated that patient age greater than 60 years, constipation, poor colon preparation and a two-person colonoscopy procedure were independently associated with lower cecal intubation rates.
Colonoscopy performed under deep sedation by experienced colonoscopists results in high cecal intubation rates. Among the significant patient-related predictors influencing the cecal intubation, the quality of the bowel preparation was the only modifiable factor. When performed by experienced hands, the one-person method was associated with higher cecal intubation rates than the two-person method.
在深度镇静患者中进行的结肠镜检查的技术性能与未镇静或轻度至中度镇静下进行的结肠镜检查不同。本研究的目的是评估在深度镇静下进行结肠镜检查时影响盲肠插管的因素。
回顾性分析 2008 年 1 月至 2008 年 12 月在一家学术医院进行健康检查的 5352 例连续接受筛查性结肠镜检查的患者。所有内镜检查均采用联合异丙酚或单独异丙酚进行深度镇静。收集的数据包括患者特征（年龄、性别、体重指数、排便习惯、腹部或骨盆手术史、肠道准备质量以及结肠憩室的存在/不存在）和内镜医师特征（经验水平、结肠镜检查程序量和仪器处理方法）。分析这些因素以评估其对盲肠插管率的影响。
未经调整的盲肠插管率为 98%，调整后的盲肠插管率为 98.3%。盲肠插管平均时间为 5.6±3.2 分钟。多变量逻辑回归分析表明，年龄大于 60 岁、便秘、肠道准备不佳和双人结肠镜检查程序与较低的盲肠插管率独立相关。
由经验丰富的内镜医师在深度镇静下进行的结肠镜检查可获得较高的盲肠插管率。在影响盲肠插管的显著患者相关预测因素中，肠道准备质量是唯一可改变的因素。由经验丰富的医生进行单人操作与双人操作相比，盲肠插管率更高。
