一种提高结肠镜检查时腺瘤检出率的简单方法：改变患者体位。
A simple method to improve adenoma detection rate during colonoscopy: altering patient position.
作者信息
Köksal Aydın Şeref, Kalkan Ismail Hakkı, Torun Serkan, Taşkıran Ismail, Öztaş Erkin, Kayaçetin Ertuğrul, Şaşmaz Nurgül
出版信息
Can J Gastroenterol. 2013 Sep;27(9):509-12. doi: 10.1155/2013/276043.
BACKGROUND
Colonoscopy is currently considered to be the gold standard method for detecting and removing adenomatous polyps. However, tandem colonoscopy studies reveal a pooled polyp miss rate of 22%.
OBJECTIVE
A prospective randomized trial was conducted to assess whether alteration of patient position during colonoscopy withdrawal increases the adenoma detection rate (ADR).
METHOD
The study group included 120 patients who presented for elective colonoscopic examination. After reaching the cecum, patients were randomly assigned in a 1:1 ratio to examination in either the left lateral position or other positions (left lateral position for the cecum, ascending colon and hepatic flexure; supine for transverse colon; and supine and right lateral position for splenic flexure, descending and sigmoid colon) first. Examination of the colon was performed segment by segment. The size, morphology and location of all polyps were recorded. Polyps were removed immediately after examination of a colon segment when all positions were completed. ADR and polyp detection rates (PDR) were calculated.
RESULTS
A total of 102 patients completed the study. Examination in the left lateral position revealed 66 polyps in 31 patients (PDR 30.3%) and 42 adenomas in 24 patients (ADR 23.5%). PDR increased to 43.1% (81 polyps in 44 patients) and the ADR to 33.3% (53 adenomas in 34 patients) after the colon was examined in the additional positions (P<0.001 and P=0.002, respectively). The increase in the number of adenomas detected was statistically significant in the transverse and sigmoid colon. The addition of position changes led to a 9.8% increase in the ADR in the transverse colon, splenic flexure, and descending and sigmoid colon. The frequency of surveillance interval was shortened in nine (8.8%) patients after examination of the colon in dynamic positions.
CONCLUSION
Alteration of patient position during colonoscopy withdrawal is a simple and effective method to improve ADR.
背景
结肠镜检查目前被认为是检测和切除腺瘤性息肉的金标准方法。然而，串联结肠镜检查研究显示息肉漏诊率汇总为22%。
目的
进行一项前瞻性随机试验，以评估结肠镜检查退镜过程中改变患者体位是否会提高腺瘤检出率（ADR）。
方法
研究组包括120例接受择期结肠镜检查的患者。到达盲肠后，患者按1:1比例随机分配，先在左侧卧位或其他体位（盲肠、升结肠和肝曲为左侧卧位；横结肠为仰卧位；脾曲、降结肠和乙状结肠为仰卧位和右侧卧位）进行检查。结肠逐段进行检查。记录所有息肉的大小、形态和位置。完成所有体位的结肠检查后，立即切除息肉。计算ADR和息肉检出率（PDR）。
结果
共有102例患者完成研究。左侧卧位检查发现31例患者有66个息肉（PDR 30.3%），24例患者有42个腺瘤（ADR 23.5%）。在额外体位检查结肠后，PDR升至43.1%（44例患者有81个息肉），ADR升至33.3%（34例患者有53个腺瘤）（分别为P<0.001和P=0.002）。横结肠和乙状结肠中检测到的腺瘤数量增加具有统计学意义。改变体位使横结肠、脾曲、降结肠和乙状结肠的ADR提高了9.8%。在动态体位检查结肠后，9例（8.8%）患者的监测间隔时间缩短。
结论
结肠镜检查退镜过程中改变患者体位是提高ADR的一种简单有效的方法。
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