Department of Colorectal Surgery, Digestive Diseases Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
Dis Colon Rectum. 2014 Mar;57(3):383-7. doi: 10.1097/DCR.0000000000000072.
Patients with an incomplete colonoscopy are potentially at risk for missed lesions.
The purpose of this work was to identify the percentage of patients completing colonic evaluation after incomplete colonoscopy, the manner in which the evaluation was completed, and the incidence of significant pathology.
This was a retrospective analysis of prospectively collected data.
The study was conducted in an outpatient colonoscopy clinic in the colorectal surgery department of a tertiary referral center.
Patients included those undergoing incomplete colonoscopy from a database of 25,645 colonoscopies performed from 1982 to 2009.
Procedures aimed at completing colorectal evaluation were included in the study.
Reason for incompletion, secondary study, its success, and findings were measured.
A total of 242 patients with incomplete colonoscopies were identified; 166 (69%) were women. The average age of patients was 59 years. Most frequent causes for incomplete colonoscopy were inadequate preparation (34%), pain (30%), and tortuosity (20%). The scope could not pass the splenic flexure in 165 patients (71%). A total of 218 patients (90%) were offered completion studies, and 179 patients (82%) complied. Seventy-three of 82 patients who had a surveillance colonoscopy had a follow-up (89%), compared with 72 (87%) of 83 with symptoms and 40 (74%) of 54 who had a screening. Barium enema (BE) was performed in 74 (41%), repeat colonoscopy in 71 (40%), CT colonography in 17 (9%), and colonoscopy under general anesthesia in 9 patients (5%). Resection with intraoperative/perioperative colonoscopy was required in 8 patients (4%). Repeat colonoscopy found 32 lesions (24 tubular adenomas, 4 tubulovillous adenomas, and 4 sessile serrated polyps) in 17 patients (24%). Radiology demonstrated new abnormalities in 11 (12%) of 91 patients, prompting 7 colonoscopies. In 3 patients, colonoscopy showed an inverted appendix, a tubulovillous adenoma, and a sigmoid stricture. Overall, clinically significant lesions were found in 19 patients (10%).
This study was limited by an incomplete colonoscopy subjectively determined at the time of colonoscopy, as well as by a lack of comparison group.
Complete colonic evaluation in patients with an incomplete colonoscopy is important. Repeat colonoscopy may be the most efficient way to achieve this.
结肠镜检查不完整的患者可能存在漏诊的风险。
本研究旨在确定完成结肠镜检查后继续进行结肠评估的患者比例、完成评估的方式以及发生显著病变的发生率。
这是一项前瞻性收集数据的回顾性分析。
研究在一家三级转诊中心的肛肠外科门诊进行。
本研究纳入了 1982 年至 2009 年期间数据库中 25645 例结肠镜检查中不完整结肠镜检查的患者。
纳入了旨在完成结直肠评估的操作。
评估未完成的原因、进行的辅助检查、其成功率和发现。
共发现 242 例结肠镜检查不完整的患者；166 例（69%）为女性。患者的平均年龄为 59 岁。结肠镜检查不完整的最常见原因是准备不充分（34%）、疼痛（30%）和迂曲（20%）。165 例患者（71%）的内镜无法通过脾曲。218 例患者（90%）接受了完成检查的建议，179 例患者（82%）同意。82 例接受随访结肠镜检查的患者中有 73 例（89%）进行了随访，83 例有症状的患者中有 72 例（87%）进行了随访，54 例筛查的患者中有 40 例（74%）进行了随访。74 例（41%）进行了钡剂灌肠（BE），71 例（40%）进行了重复结肠镜检查，17 例（9%）进行了 CT 结肠成像，9 例（5%）进行了全身麻醉下的结肠镜检查。8 例（4%）需要术中/围手术期结肠镜检查切除。重复结肠镜检查在 17 例患者（24%）中发现 32 个病变（24 个管状腺瘤、4 个管状绒毛状腺瘤和 4 个无蒂锯齿状息肉）。91 例患者中有 11 例（12%）影像学显示新的异常，促使进行了 7 次结肠镜检查。3 例患者的结肠镜检查显示阑尾内翻、管状绒毛状腺瘤和乙状结肠狭窄。总体而言，19 例患者（10%）发现了临床显著病变。
本研究的局限性在于结肠镜检查时主观判断的不完全结肠镜检查，以及缺乏对照组。
对结肠镜检查不完整的患者进行完整的结肠评估很重要。重复结肠镜检查可能是实现这一目标的最有效方法。
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