Dig Endosc. 2014 May;26(3):392-5. doi: 10.1111/den.12195.
It has been reported that double-balloon colonoscopy (DBC) is useful for patients after failed colonoscopy. In most cases previously reported, expert colonoscopists have carried out DBC. However, DBC may not require significant expertise. The objective of the present study is to assess DBC carried out by an inexperienced colonoscopist in patients referred after previously incomplete colonoscopy.
In a single center between June 2011 and September 2012, we enrolled 28 consecutive patients referred following incomplete conventional colonoscopy. The reported reasons for previous failed colonoscopy were severe pain during the procedure in 15, long redundant colon in 13 and sigmoid fixation in eight. Under instruction by an experienced colonoscopist, all procedures were carried out by a gastroenterology trainee with little colonoscopy experience. A double-balloon instrument with carbon dioxide insufflation was used under fluoroscopic guidance, with i.v. sedation. Cecal intubation rate, time to cecum and patient-reported pain using a visual analog scale (0 to 10) were evaluated.
The trainee achieved a cecal intubation in all patients (100%) without primary involvement by the experienced colonoscopist. Time to cecum ranged from 6 min to 66 min (median time to cecum 15 min 55 s). No patients required additional sedation. Visual analogue pain scores ranged from 0/10 to 10/10 (median score 2.5/10). There were no complications.
DBC may enable inexperienced colonoscopists to achieve total colonoscopy after previously incomplete conventional colonoscopy.
有报道称，双气囊结肠镜（DBC）对结肠镜检查失败的患者很有用。在之前报道的大多数情况下，都是由专家级的结肠镜医师来进行 DBC。然而，DBC 可能并不需要很高的专业技能。本研究的目的是评估在先前不完全结肠镜检查后转诊的患者中，经验不足的结肠镜医师进行 DBC 的情况。
在 2011 年 6 月至 2012 年 9 月的单中心研究中，我们纳入了 28 例因先前结肠镜检查不完全而转诊的连续患者。先前结肠镜检查失败的原因报告为：15 例为检查过程中疼痛剧烈，13 例为结肠冗长，8 例为乙状结肠固定。在有经验的结肠镜医师的指导下，所有操作均由一位经验较少的胃肠病学受训医师进行。在透视引导下，使用二氧化碳注气的双气囊仪器，并进行静脉镇静，评估盲插盲进盲肠率、到达盲肠的时间以及患者使用视觉模拟评分法（0 至 10 分）报告的疼痛程度。
受训医师在没有经验丰富的结肠镜医师直接参与的情况下，成功使所有患者（100%）盲插盲进盲肠。到达盲肠的时间为 6 分钟至 66 分钟（中位数到达盲肠时间为 15 分 55 秒）。没有患者需要额外的镇静。视觉模拟疼痛评分范围为 0/10 至 10/10（中位数评分为 2.5/10）。无并发症发生。
DBC 可能使经验不足的结肠镜医师能够在先前不完全的常规结肠镜检查后完成全结肠镜检查。
