Triantafyllou Konstantinos, Tziatzios Georgios, Sioulas Athanasios D, Beintaris Iosif, Gouloumi Alina-Roxani, Panayiotides Ioannis G, Dimitriadis George D
Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Medical School, University of Athens, "Attikon" University General Hospital, Athens, Greece.
Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Medical School, University of Athens, "Attikon" University General Hospital, Athens, Greece.
Dig Liver Dis. 2016 Feb;48(2):176-81. doi: 10.1016/j.dld.2015.11.024. Epub 2015 Dec 2.
Techniques have been implemented to improve colonoscopy adenoma detection rate (ADR) in the right colon.
AIMS & METHODS: We prospectively examined the additional diagnostic yield of right colon examination with colonoscope retroflexion in consecutive, symptomatic and screening-surveillance patients. Right colon was examined in forward-view first and thereafter, retroflexion was performed to re-inspect it.
Right colon examination in retroflexion was achieved in 620 (92%) patients. Increased inserted scope length to the cecum (OR: 0.48 [95% CI: 0.27-0.84]) and elderly status (OR: 0.53 [95% CI: 0.430-0.94]) predicted retrofexion failure. Forward-view colonoscopy detected 134 polyps and 112 adenomas in 105 and 85 patients, respectively. Scope retroflexion revealed 7 missed (6 adenomas--2 advanced) polyps in 7 patients; indicating 4.96 (95% CI: 1.37-8.55) % and 5.1 (95% CI: 1.12-9.05) % per-polyp and per-adenoma miss rates, respectively. In ITT analysis, per-patient polyp and adenoma miss rates were 1.041% and 0.89%, respectively. Among screening-surveillance patients, retroflexion detected 3 missed adenomas (2 advanced) in 3 patients, resulting in changed surveillance schedule in 2 of them (5.12 per 1000 screening-surveillance patients). Early study termination was favored by low right colon ADR improvement and lacking substantial surveillance interval change.
The additional diagnostic yield of scope retroflexion in the right colon is questionable.
已采用多种技术来提高右半结肠结肠镜腺瘤检出率（ADR）。
我们前瞻性地研究了在连续的有症状和筛查监测患者中，使用结肠镜反转技术对右半结肠进行检查的额外诊断收益。首先采用直视方式检查右半结肠，然后进行反转以重新检查。
620例（92%）患者成功进行了右半结肠反转检查。到达盲肠的插入镜身长度增加（比值比：0.48 [95%置信区间：0.27 - 0.84]）和老年状态（比值比：0.53 [95%置信区间：0.430 - 0.94]）预示着反转失败。直视结肠镜检查在105例和85例患者中分别检测到134枚息肉和112枚腺瘤。镜身反转在7例患者中发现了7枚漏诊的（6枚腺瘤 - 2枚进展期）息肉；每息肉漏诊率和每腺瘤漏诊率分别为4.96%（95%置信区间：1.37 - 8.55）和5.1%（95%置信区间：1.12 - 9.05）。在意向性分析中，每患者息肉和腺瘤漏诊率分别为1.041%和0.89%。在筛查监测患者中，反转检查在3例患者中发现了3枚漏诊的腺瘤（2枚进展期），其中2例患者的监测计划因此改变（每1000例筛查监测患者中有5.12例）。由于右半结肠ADR改善程度低且缺乏实质性的监测间隔变化，研究提前终止。
右半结肠镜身反转的额外诊断收益值得怀疑。
