Division of Gastroenterology, Department of Internal Medicine, Myongji Hospital, Kwandong University College of Medicine, 697-24 Hwajung-dong, Dukyang-ku, Goyang, 412-270, Republic of Korea.
Surg Endosc. 2013 Jun;27(6):2209-15. doi: 10.1007/s00464-012-2741-2. Epub 2013 Jan 26.
Same-day bidirectional endoscopy is commonly performed in clinical practice. However, the optimal sequence of procedures for same-day bidirectional endoscopy has not been established. The purpose of this study was to compare colonoscopy performance and quality between patients who underwent colonoscopy before or after esophagogastroduodenoscopy (EGD).
A total of 1,103 patients were prospectively randomized into either the EGD-colonoscopy or colonoscopy-EGD sequence groups. Three patients who had incomplete cecal intubation due to structural obstruction were excluded from the analysis. During colonoscopy, colonoscopic parameters including difficult cecal intubation (cecal intubation failure and prolonged insertion), insertion time, and adenoma detection rate were measured. Out of 1,100 patients, 524 patients without sedation completed a questionnaire designed to assess subjective discomfort experienced.
The colonoscopy completion rate was 99.5 %, and the rate of difficult cecal intubation was 14.5 %. The time from insertion to reaching the cecum (minutes:seconds, 06:32 ± 04:26 vs. 06:40 ± 04:09, p = 0.649), difficult cecal intubation ratio (76 of 550 vs. 83 of 550, p = 0.593), and colonoscopic adenoma detection rate (29.8 vs. 25.5 %, p = 0.106) did not differ between the groups. On multivariate analysis, difficulty with cecal intubation increased specifically in women, in patients aged 55 years and over, in patients with poor bowel preparation, and in patients who had undergone previous abdominal surgery. Subjective discomfort after EGD was higher in the colonoscopy-EGD sequence group.
The procedural sequence did not affect colonoscopy performance and quality in same-day bidirectional endoscopy, and factors such as old age, female gender, poor bowel preparation, and previous abdominal surgery were confirmed to adversely affect colonoscopy. In addition, the EGD-colonoscopy sequence induced less subjective discomfort during EGD.
同日双向内镜检查在临床实践中很常见。然而，同日双向内镜检查的最佳程序顺序尚未确定。本研究的目的是比较经食管胃十二指肠镜（EGD）检查前或后行结肠镜检查对患者的结肠镜检查表现和质量的影响。
共前瞻性随机将 1103 例患者分为 EGD-结肠镜检查或结肠镜检查-EGD 序列组。由于结构阻塞，3 例患者未能完全插管至盲肠，因此被排除在分析之外。在结肠镜检查期间，测量包括难以插管（插管失败和插入时间延长）、插入时间和腺瘤检出率在内的结肠镜参数。在 1100 例患者中，524 例无镇静的患者完成了一份旨在评估主观不适的问卷。
结肠镜检查完成率为 99.5%，难以插管的发生率为 14.5%。从插入到到达盲肠的时间（分钟：秒，06:32 ± 04:26 比 06:40 ± 04:09，p = 0.649）、难以插管的比例（76/550 比 83/550，p = 0.593）和结肠镜检查腺瘤检出率（29.8%比 25.5%，p = 0.106）在两组之间无差异。多变量分析显示，女性、55 岁及以上、肠道准备不良和既往腹部手术的患者更容易出现插管困难。结肠镜检查-EGD 序列组的 EGD 后主观不适较高。
程序顺序不会影响同日双向内镜检查中的结肠镜检查表现和质量，年龄较大、女性、肠道准备不良和既往腹部手术等因素被证实会对结肠镜检查产生不利影响。此外，EGD-结肠镜检查顺序在 EGD 时引起的主观不适较小。
