Holt Edward W, Yimam Kidist K, Ma Hanley, Shaw Richard E, Sundberg Richard A, Verhille Michael S
Department of Gastroenterology,California Pacific Medical Center, San Francisco, CA USA.
Department of Medicine,California Pacific Medical Center, San Francisco, CA USA.
J Gastrointestin Liver Dis. 2014 Jun;23(2):135-40. doi: 10.15403/jgld.2014.1121.232.ewh1.
BACKGROUND & AIMS: A number of factors have been identified that influence the yield of screening colonoscopy. The perceived tolerability of bowel preparation has not been studied as a predictor of quality outcomes in colonoscopy. We aimed to characterize the association between patient-perceived tolerability of bowel preparation and polyp detection during colonoscopy.
We performed a cross-sectional cohort study of 413 consecutive adult patients presenting for outpatient colonoscopy at two outpatient endoscopy centers at our institution. We developed a standardized questionnaire to assess the patient's experience with bowel preparation. Bowel preparation quality was measured using the validated Ottawa scale and colonoscopic findings were recorded for each patient. The primary outcome was polyp detection and the secondary outcome was the quality of bowel preparation.
Patient-reported clarity of effluent during bowel preparation correlated poorly with Ottawa score during colonoscopy, ĸ=0.15. Female gender was an independent risk factor for a poorly tolerated bowel prep (OR 3.93, 95% CI 2.30 - 6.72, p<0.001). Report of a poorly tolerated bowel prep was independently associated with the primary outcome, polyp detection (OR 0.39, 95% CI 0.18 - 0.84, p=0.02) and also with the secondary outcome, lower quality bowel preparation (OR 2.39, 95% CI 1.17 - 4.9, p=0.02).
A patient-perceived negative experience with bowel preparation independently predicted both a lower quality bowel preparation and a lower rate of polyp of detection. Assessment of the tolerability of bowel preparation before colonoscopy may be a clinically useful predictor of quality outcomes during colonoscopy.
已确定多种影响结肠镜筛查检出率的因素。肠道准备的可耐受程度尚未作为结肠镜检查质量结果的预测指标进行研究。我们旨在描述患者对肠道准备的可耐受程度与结肠镜检查期间息肉检测之间的关联。
我们对在我院两个门诊内镜中心接受门诊结肠镜检查的413例连续成年患者进行了一项横断面队列研究。我们编制了一份标准化问卷，以评估患者的肠道准备体验。使用经过验证的渥太华量表测量肠道准备质量，并记录每位患者的结肠镜检查结果。主要结局是息肉检测，次要结局是肠道准备质量。
患者报告的肠道准备期间排泄物清晰度与结肠镜检查期间的渥太华评分相关性较差，κ=0.15。女性是肠道准备耐受性差的独立危险因素（比值比3.93，95%置信区间2.30 - 6.72，p<0.001）。报告肠道准备耐受性差与主要结局息肉检测独立相关（比值比0.39，95%置信区间0.18 - 0.84，p=0.02），也与次要结局肠道准备质量较低相关（比值比2.39，95%置信区间1.17 - 4.9，p=0.02）。
患者对肠道准备的负面体验独立预测了较低质量的肠道准备和较低的息肉检出率。结肠镜检查前评估肠道准备的可耐受程度可能是结肠镜检查期间质量结果的一项临床有用预测指标。
