Division of Gastroenterology and Hepatology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea.
J Gastroenterol Hepatol. 2013 Nov;28(11):1733-7. doi: 10.1111/jgh.12264.
Colonoscopy (CFS) is a valuable diagnostic tool in patients with hematochezia. However, the optimal preparation method of emergent CFS for hematochezia has not been defined. We investigated the clinical effectiveness of bowel preparation of patients with hematochezia using polyethylene glycol (PEG) solution and glycerin or water enemas.
The medical records of the past 7 years were reviewed. Patients presenting with hematochezia that occurred within 24 h before admission were eligible for the study. All patients underwent CFS within 24 h after visiting the emergency room for hematochezia. Patients were classified into two groups according to the preparation method used (enema vs. PEG).
Overall, 194 patients (125 enema vs. 69 PEG) were enrolled. The diagnostic rate of bleeding focus was lower in the enema group than in the PEG group (84% vs. 97.1%, P = 0.008). Performance of endoscopic hemostasis at the initial CFS was more frequent in the enema group than in the PEG group (40.8% vs. 10.1%, P < 0.001). The rate of repeated CFS was higher in the enema group than in the PEG group (44.0% vs. 18.8%, P < 0.001). Post-polypectomy bleeding (n = 33) was diagnosed during the initial study and was treated endoscopically. In cases of post-polypectomy bleeding, CFS (93.9%) was performed after an enema in all but two cases.
In hematochezia patients, the PEG group showed a higher diagnostic rate and lower rate of repeated CFS. However, emergent CFS after an enema only seems to be useful in patients with severe hematochezia or if the bleeding focus can be presumed.
结肠镜检查（CFS）是便血患者有价值的诊断工具。然而，对于便血紧急 CFS 的最佳准备方法尚未确定。我们研究了使用聚乙二醇（PEG）溶液和甘油或水灌肠剂对便血患者进行肠道准备的临床效果。
回顾过去 7 年的病历。符合条件的患者为便血在入院前 24 小时内发生的患者。所有患者在因便血就诊后 24 小时内进行 CFS。根据使用的准备方法（灌肠剂与 PEG）将患者分为两组。
共有 194 名患者（125 名灌肠剂组与 69 名 PEG 组）入组。灌肠组的出血病灶诊断率低于 PEG 组（84%比 97.1%，P=0.008）。在初次 CFS 时进行内镜止血的操作在灌肠组比 PEG 组更频繁（40.8%比 10.1%，P<0.001）。灌肠组再次进行 CFS 的比率高于 PEG 组（44.0%比 18.8%，P<0.001）。肠息肉切除术后出血（n=33）在初次研究期间诊断，并进行内镜治疗。在肠息肉切除术后出血的情况下，除两例外，所有病例均通过灌肠进行初次 CFS（93.9%）。
在便血患者中，PEG 组显示出更高的诊断率和更低的重复 CFS 率。然而，灌肠后紧急 CFS 似乎仅对严重便血或可以推测出血病灶的患者有用。
