肠道准备类型对结肠镜检查质量的影响：一项基于社区的多中心研究。
Impact of bowel preparation type on the quality of colonoscopy: a multicenter community-based study.
作者信息
Martin Daniel, Walayat Saqib, Ahmed Zohair, Dhillon Sonu, Asche Carl V, Puli Srinivas, Ren Jinma
机构信息
Department of Gastroenterology, OSF Saint Francis Medical Center, Peoria, IL, USA.
Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA.
出版信息
J Community Hosp Intern Med Perspect. 2016 Apr 25;6(2):31074. doi: 10.3402/jchimp.v6.31074. eCollection 2016.
BACKGROUND
High-quality bowel preparation is crucial for achieving the goals of colonoscopy. However, choosing a bowel preparation in clinical practice can be challenging because of the many formulations. This study aims to assess the impact the type of bowel preparation on the quality of colonoscopy in a community hospital setting.
METHODS
A retrospective, observational study was conducted utilizing a colonoscopy screening/surveillance database in central Illinois during the period of January 1, 2010, to March 31, 2014. Patients without bowel preparation assessment were excluded from this study. Controlling for the confounders, generalized linear models were used to estimate the adjusted impact [odds ratio (OR)] of bowel preparation type on the quality of preparation (excellent, good, fair, and poor), and on the detection of advanced adenoma. The association between the time of withdrawal after insertion and the quality of preparation was also examined using a linear model.
RESULTS
A total of 28,368 colonoscopies; half the patients were male, and the average age was 61±9 years. Polyethylene glycol (PEG) was used in the majority (70.2%) of bowel preparations, followed by sodium sulfate (21.4%), sodium phosphate (2.5%), magnesium sulfate (0.4%), and others. Compared with PEG, magnesium sulfate had a poorer quality of bowel preparations (OR=0.6, 95% CI 0.4-0.9; p<0.05), whereas the quality of bowel preparation was significantly improved by using sodium sulfate (OR=5.7, 95% CI 5.4-6.1; p<0.001) and sodium phosphate (OR=2.1, 95% CI 1.8-2.5; p<0.001). For those who had adequate bowel preparation, the better quality of preparation significantly increased the detection rate of advanced adenoma (5.0, 3.6, and 2.9% for excellent, good, and fair, respectively).
CONCLUSION
When possible, sodium sulfate-based preparations should be recommended in the community setting for colonoscopy because of their high quality of bowel preparation.
背景
高质量的肠道准备对于实现结肠镜检查的目标至关重要。然而，由于有多种制剂，在临床实践中选择肠道准备方法可能具有挑战性。本研究旨在评估在社区医院环境中肠道准备类型对结肠镜检查质量的影响。
方法
利用伊利诺伊州中部2010年1月1日至2014年3月31日期间的结肠镜筛查/监测数据库进行了一项回顾性观察研究。未进行肠道准备评估的患者被排除在本研究之外。在控制混杂因素的情况下，使用广义线性模型来估计肠道准备类型对准备质量（优秀、良好、一般和差）以及高级别腺瘤检测的调整影响[比值比（OR）]。还使用线性模型检查插入后退出时间与准备质量之间的关联。
结果
总共进行了28368例结肠镜检查；一半患者为男性，平均年龄为61±9岁。大多数（70.2%）肠道准备使用聚乙二醇（PEG），其次是硫酸钠（21.4%）、磷酸钠（2.5%）、硫酸镁（0.4%）和其他。与PEG相比，硫酸镁的肠道准备质量较差（OR=0.6，95%CI 0.4-0.9；p<0.05），而使用硫酸钠（OR=5.7，95%CI 5.4-6.1；p<0.001）和磷酸钠（OR=2.1，95%CI 1.8-2.5；p<0.001）可显著提高肠道准备质量。对于肠道准备充分的患者，更好的准备质量显著提高了高级别腺瘤的检出率（优秀、良好和一般的分别为5.0%、3.6%和2.9%）。
结论
在社区环境中进行结肠镜检查时，如有可能，应推荐使用基于硫酸钠的制剂，因为它们的肠道准备质量高。
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