Xhaja Xhileta, Church James
Department of Colorectal Surgery, Digestive Diseases Institute, Cleveland Clinic Foundation, Desk A 30, 9500 Euclid Ave, Cleveland, OH, 44195, USA,
Surg Endosc. 2014 Jun;28(6):1936-9. doi: 10.1007/s00464-014-3418-9. Epub 2014 Feb 25.
There is more to a high-quality colonoscopy than reaching the cecum or finding adenomas. Gentle insertion involves ancillary techniques, some of which are impossible in patients receiving deep sedation. The aim of this study was to assess the importance of ancillary techniques in achieving a comfortable, complete colonoscopy.
This was a prospective study of 500 consecutive outpatient colonoscopies performed by a single endoscopist. During the procedure, note was taken of various ancillary techniques used to facilitate insertion: turning the patient, patient holding their breath, abdominal pressure. The success of these techniques in helping scope advancement was also noted. After the procedure the patient was asked to rate the severity of their pain and their degree of satisfaction with the examination.
A total of 238 women and 262 men participated in the study, and colonoscopy was complete in 96.2 and 98.5%, respectively. Overall, 97% of patients received versed alone (average dose 2 mg), and 3% received a narcotic (average dose 46 U). Average pain score was 3.9 on a scale of 1 (least pain) to 10 (worst pain), and average satisfaction with the procedure as a whole was 9.5 on a similar scale. Ancillary techniques of holding breath, directed abdominal pressure, and turning to the left, right, and prone were used in 46, 56, 17, 23, and 4% of examinations, respectively. Each technique was effective in helping insertion in over 70% of cases. Turning the patient was also used to clear stool, open the colon, or facilitate polypectomy in another 33 cases. Multiple techniques were used in 49% of patients.
The use of ancillary techniques to facilitate colonoscope insertion helps avoid the expense and potential side effects of deep sedation.
高质量的结肠镜检查不仅仅是到达盲肠或发现腺瘤。轻柔插入涉及辅助技术，其中一些技术在接受深度镇静的患者中是不可能实现的。本研究的目的是评估辅助技术在实现舒适、完整的结肠镜检查中的重要性。
这是一项对由一名内镜医师连续进行的500例门诊结肠镜检查的前瞻性研究。在检查过程中，记录了用于辅助插入的各种技术：转动患者、患者屏气、腹部按压。还记录了这些技术在帮助推进结肠镜方面的成功率。检查结束后，要求患者对疼痛的严重程度以及对检查的满意度进行评分。
共有238名女性和262名男性参与了研究，结肠镜检查的完成率分别为96.2%和98.5%。总体而言，97%的患者仅接受了咪达唑仑（平均剂量2毫克），3%的患者接受了麻醉剂（平均剂量46单位）。平均疼痛评分为3.9分（范围为1分（最轻疼痛）至10分（最严重疼痛）），对整个检查的平均满意度在类似的评分表上为9.5分。屏气、定向腹部按压以及向左、向右和俯卧转动等辅助技术分别在46%、56%、17%、23%和4%的检查中使用。每种技术在超过70%的病例中对辅助插入有效。在另外33例病例中，转动患者还用于清除粪便、打开结肠或便于息肉切除。49%的患者使用了多种技术。
使用辅助技术促进结肠镜插入有助于避免深度镇静的费用和潜在副作用。
