Alghamry Alaa, Ponnuswamy Sureshkumar K, Agarwal Aditya, Moattar Hadi, Yerkovich Stephanie T, Vandeleur Ann E, Thomas James, Croese John, Rahman Tony, Hodgson Ruth
Department of Gastroenterology and Hepatology, Centre for Service and Quality Improvement, The Prince Charles Hospital, Chermside, Queensland, Australia.
School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
J Dig Dis. 2017 Mar;18(3):160-168. doi: 10.1111/1751-2980.12458.
Aspiration risk, especially with propofol sedation, remains a concern after split-dose bowel preparation of up to 1 L polyethylene glycol for the procedure. We aimed to identify the ideal timing of bowel preparation to achieve optimal colon cleansing with no increased risk of aspiration.
A total of 892 consecutive patients undergoing simultaneous esophagogastroduodenoscopy (EGD) and colonoscopy were prospectively recruited. Residual gastric volume (RGV) and pH of gastric contents were measured at EGD, and patients' characteristics, runway time (duration between completion of the final liter of bowel preparation and colonoscopy commencement), and cleansing quality were recorded.
A shorter runway time resulted in better colon cleansing (r = -0.124, P < 0.001). No correlation between runway time and RGV or pH was found (r = -0.017, P = 0.62 and r = -0.030, P = 0.47, respectively). RGV and pH did not differ significantly with runway time of 4 or 5 h. RGV with runway time ≤3 h was 35.9 ± 11.8 mL and 17.4 ± 0.6 mL after runway time >3 h (P < 0.001). No aspiration pneumonia occurred. The only factors independently related to higher RGV were younger age and male sex.
The consumption of bowel preparation agent within 3-4 h before propofol sedation resulted in a similar RGV and pH as those achieved by more prolonged fasting, with no increased risk of aspiration even in patients perceived to be at high risk.
在为该手术进行高达1升聚乙二醇的分剂量肠道准备后，误吸风险，尤其是丙泊酚镇静后的误吸风险，仍然令人担忧。我们旨在确定肠道准备的理想时机，以实现最佳的结肠清洁效果，同时不增加误吸风险。
前瞻性招募了892例连续接受食管胃十二指肠镜检查（EGD）和结肠镜检查的患者。在EGD时测量残余胃容积（RGV）和胃内容物的pH值，并记录患者的特征、准备时间（最后一升肠道准备完成至结肠镜检查开始之间的持续时间）和清洁质量。
较短的准备时间可带来更好的结肠清洁效果（r = -0.124，P < 0.001）。未发现准备时间与RGV或pH值之间存在相关性（分别为r = -0.017，P = 0.62和r = -0.030，P = 0.47）。RGV和pH值在4或5小时的准备时间下无显著差异。准备时间≤3小时时的RGV为35.9 ± 11.8毫升，准备时间>3小时后为17.4 ± 0.6毫升（P < 0.001）。未发生吸入性肺炎。与较高RGV独立相关的唯一因素是年龄较小和男性。
在丙泊酚镇静前3 - 4小时内服用肠道准备剂，其RGV和pH值与更长时间禁食时相似，即使在被认为高风险的患者中也不会增加误吸风险。
