Guo Chuan-Guo, Zhang Feifei, Ji Rui, Li Yueyue, Li Lixiang, Zuo Xiu-Li, Li Yan-Qing
Department of Gastroenterology, Laboratory of Translational Gastroenterology, Shandong University, Qilu Hospital, Jinan, Shandong Province, China.
Department of Epidemiology, School of Public Health, Shandong University, Jinan, Shandong Province, China.
Endoscopy. 2017 Mar;49(3):243-250. doi: 10.1055/s-0042-122013. Epub 2017 Jan 27.
Interval colorectal cancers detected after screening colonoscopy are more likely to be associated with missed lesions in the proximal colon. The aim of this study was to determine whether segmental re-examination of the proximal colon could increase the proximal adenoma detection rate (ADR) and to evaluate the time-effectiveness of this approach. Patients undergoing colonoscopy were recruited into the prospective randomized controlled study. They were randomly assigned to the segmental re-examination group, in which the proximal colon was examined twice segmentally, and a control group in which the withdrawal time was extended (EWT). Detection rates were calculated and compared for all polyps and adenomas in both the proximal colon and the whole colon. Withdrawal times were recorded and compared. A total of 360 patients were included in the study (re-examination 178 vs. EWT 182). The proximal ADR in the re-examination group was higher than that in the EWT group (33.1 % vs. 23.6 %; = 0.045). More proximal adenomas were detected per patient in the re-examination group (0.54 vs. 0.36; = 0.048). The ADR of the whole colon was similar in the two groups. Proximal withdrawal time was also similar (re-examination 4.29 ± 1.23 minutes vs. EWT 4.34 ± 1.36 minutes; = 0.74). In addition, there was no statistically significant difference in the total duration of the colonoscopy between the two groups. Segmental re-examination of the proximal colon increased the proximal ADR and the number of proximal adenomas detected, and was accomplished easily and safely without increasing the overall examination time.
ClinicalTrials.gov (NCT02581475).
筛查结肠镜检查后发现的间隔期结直肠癌更有可能与近端结肠病变漏诊相关。本研究的目的是确定对近端结肠进行分段复查是否能提高近端腺瘤检出率（ADR），并评估该方法的时间有效性。接受结肠镜检查的患者被纳入前瞻性随机对照研究。他们被随机分配到分段复查组，在该组中对近端结肠进行两次分段检查，以及对照组，在对照组中延长退镜时间（EWT）。计算并比较近端结肠和全结肠中所有息肉和腺瘤的检出率。记录并比较退镜时间。共有360例患者纳入研究（复查组178例 vs. EWT组182例）。复查组的近端ADR高于EWT组（33.1% vs. 23.6%；P = 0.045）。复查组每位患者检测到的近端腺瘤更多（0.54 vs. 0.36；P = 0.048）。两组全结肠的ADR相似。近端退镜时间也相似（复查组4.29±1.23分钟 vs. EWT组4.34±1.36分钟；P = 0.74）。此外，两组结肠镜检查的总时长无统计学显著差异。对近端结肠进行分段复查可提高近端ADR和检测到的近端腺瘤数量，且操作简便安全，未增加总体检查时间。
ClinicalTrials.gov（NCT02581475）。
