Brahmania Mayur, Park Jei, Svarta Sigrid, Tong Jessica, Kwok Ricky, Enns Robert
Department of Medicine, Division of Gastroenterology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia.
Can J Gastroenterol. 2012 Sep;26(9):589-92. doi: 10.1155/2012/353457.
Cecal intubation is one of the goals of a quality colonoscopy; however, many factors increasing the risk of incomplete colonoscopy have been implicated. The implications of missed pathology and the demand on health care resources for return colonoscopies pose a conundrum to many physicians. The optimal course of action after incomplete colonoscopy is unclear.
To assess endoscopic completion rates of previously incomplete colonoscopies, the methods used to complete them and the factors that led to the previous incomplete procedure.
All patients who previously underwent incomplete colonoscopy (2005 to 2010) and were referred to St Paul's Hospital (Vancouver, British Columbia) were evaluated. Colonoscopies were re-attempted by a single endoscopist. Patient charts were reviewed retrospectively.
A total of 90 patients (29 males) with a mean (± SD) age of 58 ± 13.2 years were included in the analysis. Thirty patients (33%) had their initial colonoscopy performed by a gastroenterologist. Indications for initial colonoscopy included surveillance or screening (23%), abdominal pain (15%), gastrointestinal bleeding (29%), change in bowel habits or constitutional symptoms (18%), anemia (7%) and chronic diarrhea (8%). Reasons for incomplete colonoscopy included poor preparation (11%), pain or inadequate sedation (16%), tortuous colon (30%), diverticular disease (6%), obstructing mass (6%) and stricturing disease (10%). Reasons for incomplete procedures in the remaining 21% of patients were not reported by the referring physician. Eighty-seven (97%) colonoscopies were subsequently completed in a single attempt at the institution. Seventy-six (84%) colonoscopies were performed using routine manoeuvres, patient positioning and a variable-stiffness colonoscope (either standard or pediatric). A standard 160 or 180 series Olympus gastroscope (Olympus, Japan) was used in five patients (6%) to navigate through sigmoid diverticular disease; a pediatric colonoscope was used in six patients (7%) for similar reasons. Repeat colonoscopy on the remaining three patients (3%) failed: all three required surgery for strictures (two had obstructing malignant masses and one had a severe benign obstructing sigmoid diverticular stricture).
Most patients with previous incomplete colonoscopy can undergo a successful repeat colonoscopy at a tertiary care centre with instruments that are readily available to most gastroenterologists. Other modalities for evaluation of the colon should be deferred until a second attempt is made at an expert centre.
盲肠插管是高质量结肠镜检查的目标之一；然而，许多因素被认为会增加结肠镜检查不完整的风险。漏诊病变的影响以及再次结肠镜检查对医疗资源的需求给许多医生带来了难题。结肠镜检查不完整后的最佳行动方案尚不清楚。
评估既往结肠镜检查不完整患者的内镜完成率、完成检查所采用的方法以及导致先前检查不完整的因素。
对所有在2005年至2010年期间接受过不完整结肠镜检查并转诊至圣保罗医院（不列颠哥伦比亚省温哥华）的患者进行评估。由一名内镜医师再次尝试进行结肠镜检查。对患者病历进行回顾性审查。
共有90例患者（29例男性）纳入分析，平均年龄为58±13.2岁。30例患者（33%）的初次结肠镜检查由胃肠病学家进行。初次结肠镜检查的适应证包括监测或筛查（23%）、腹痛（15%）、胃肠道出血（29%）、排便习惯改变或全身症状（18%）、贫血（7%）和慢性腹泻（8%）。结肠镜检查不完整的原因包括准备不佳（11%）、疼痛或镇静不足（16%）、结肠迂曲（30%）、憩室病（6%）、阻塞性肿物（6%）和狭窄性疾病（10%）。其余21%患者检查不完整的原因，转诊医生未报告。随后，87例（97%）结肠镜检查在该机构一次尝试中完成。76例（84%）结肠镜检查采用常规操作、患者体位调整以及可变硬度结肠镜（标准型或儿童型）。5例患者（6%）使用标准的160或180系列奥林巴斯胃镜（日本奥林巴斯公司）通过乙状结肠憩室病区域；6例患者（7%）出于类似原因使用儿童型结肠镜。其余3例患者（3%）再次结肠镜检查失败：所有3例均因狭窄需要手术治疗（2例有阻塞性恶性肿物，1例有严重的良性阻塞性乙状结肠憩室狭窄）。
大多数既往结肠镜检查不完整的患者在三级医疗中心可以使用大多数胃肠病学家 readily available 的器械成功进行再次结肠镜检查。在专家中心进行第二次尝试之前，应推迟使用其他评估结肠的方法。 （注：原文中“readily available”直译为“随时可用的”，这里结合语境意译为“ readily available 的器械”，可能原文表述有误，推测应为“readily available instruments”，但按要求未做修改。）
