Graduate School of Tianjin Medical University, Tianjin, China.
Tianjin Hospital of Integrated Traditional Chinese and Western Medicine, Tianjin, China.
Dig Endosc. 2018 May;30(3):321-331. doi: 10.1111/den.13012. Epub 2018 Feb 5.
Colonoscopy is an excellent screening tool for colorectal cancer. There are four colonoscopy techniques: air insufflation, CO insufflation, water exchange, and water immersion. Some studies reported that the latter three methods are better than the criterion standard (air insufflation), whereas some studies did not. In order to evaluate the efficacy of the four colonoscopy techniques, a network meta-analysis was carried out.
We searched randomized controlled trials (RCT) published up to September 2017 from PubMed, Embase, Cochrane library, and Web of Science. Studies referencing the comparison between at least two of air insufflation, CO insufflation, water exchange, and water immersion were selected. Primary outcomes included pain score during insertion, polyp detection rate, and adenoma detection rate, and secondary outcomes included cecal intubation time and cecal intubation rate. Mean differences or odds ratios and their corresponding 95% credible intervals were pooled with Bayesian modeling.
Forty RCT with 13 734 patients were included in this network meta-analysis. Our analysis showed that air insufflation had the highest pain score (surface under the cumulative ranking curve [SUCRA]: 98.8%) and the lowest detection rate of adenoma (SUCRA: 21.3%) and polyp (SUCRA: 16.8%). Water exchange had the lowest pain score (SUCRA: 1.1%) and highest detection rate of adenoma (SUCRA: 96.0%) and polyp (SUCRA: 98.9%), although it led to the longest cecal intubation time (SUCRA: 86.9%).
Air insufflation might be the most unsatisfactory colonoscopy. Meanwhile, water exchange might be the most efficient colonoscopy.
结肠镜检查是结直肠癌筛查的优秀工具。结肠镜检查有四种技术：气腹充气、CO2 充气、水交换和水浸。一些研究报告称，后三种方法优于标准（气腹充气），而一些研究则没有。为了评估这四种结肠镜检查技术的疗效，我们进行了一项网络荟萃分析。
我们从 PubMed、Embase、Cochrane 图书馆和 Web of Science 中检索了截至 2017 年 9 月发表的随机对照试验（RCT）。选择了参考至少两种气腹充气、CO2 充气、水交换和水浸比较的研究。主要结局包括插入时的疼痛评分、息肉检出率和腺瘤检出率，次要结局包括盲肠插管时间和盲肠插管率。采用贝叶斯模型对均值差或比值比及其相应的 95%可信区间进行汇总。
本网络荟萃分析共纳入 40 项 RCT 共 13734 例患者。我们的分析表明，气腹充气的疼痛评分最高（累积排序曲线下面积 [SUCRA]：98.8%），腺瘤（SUCRA：21.3%）和息肉（SUCRA：16.8%）的检出率最低。水交换的疼痛评分最低（SUCRA：1.1%），腺瘤（SUCRA：96.0%）和息肉（SUCRA：98.9%）的检出率最高，但盲肠插管时间最长（SUCRA：86.9%）。
气腹充气可能是最不理想的结肠镜检查方法。同时，水交换可能是最有效的结肠镜检查方法。
