Ponte Ana, Pinho Rolando, Rodrigues Adélia, Proença Luísa, Silva Joana, Rodrigues Jaime P, Sousa Mafalda, Carlos Silva João, Carvalho João
Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
GE Port J Gastroenterol. 2018 Nov;25(6):285-290. doi: 10.1159/000485803. Epub 2018 Feb 6.
This study aims to evaluate the role of an advanced endoscopist to study the entire colon after an incomplete colonoscopy.
All patients with an elective incomplete colonoscopy performed under deep sedation in our department between January 2010 and October 2016 were included. Patients with a colonic stenosis, an inadequate bowel preparation, or a colonoscopy performed without deep sedation were excluded. Included patients were followed up to evaluate if and what type of subsequent examinations (colonoscopy by an advanced endoscopist, single-balloon enteroscopy [SBE], and/or CT colonography) was performed to complete the study of the entire colon. Lesions found during these subsequent examinations were also recorded.
Ninety-three patients had an incomplete colonoscopy, with no diagnosis of colorectal cancer (CRC) and a high-risk polyp rate of 5.4% ( = 5). Seventy-seven patients with incomplete colonoscopies underwent subsequent examinations, namely CT colonography in 45.5% ( = 35), colonoscopy by an advanced endoscopist in 53.2% ( = 41), and SBE in 13% ( = 10). In the 49 patients who performed either colonoscopy ( = 39) or SBE ( = 10) by an advanced endoscopist, the cecal intubation rate was 100%, and high-risk polyps were found in 26.5% ( = 13) and CRC in 4.1%. CT colonography revealed findings consistent with polyps and CRC in 22.9% ( = 8) and 2.9% ( = 1) of the cases, respectively. Colonoscopy was further repeated in 6 patients with suspected polyps in CT colonography, confirming the initial diagnosis in 5 patients.
Colonoscopy by an advanced endoscopist achieved cecal intubation in all patients, representing a good choice after an incomplete colonoscopy.
本研究旨在评估资深内镜医师在结肠镜检查不完全时对整个结肠进行检查的作用。
纳入2010年1月至2016年10月期间在我科接受深度镇静下择期结肠镜检查但未完成的所有患者。排除患有结肠狭窄、肠道准备不充分或未进行深度镇静下结肠镜检查的患者。对纳入患者进行随访，以评估是否以及进行了何种后续检查（由资深内镜医师进行结肠镜检查、单气囊小肠镜检查[SBE]和/或CT结肠成像）来完成对整个结肠的检查。还记录了这些后续检查中发现的病变。
93例患者结肠镜检查未完成，未诊断出结直肠癌（CRC），高危息肉率为5.4%（n = 5）。77例结肠镜检查未完成的患者接受了后续检查，其中45.5%（n = 35）进行了CT结肠成像，53.2%（n = 41）由资深内镜医师进行了结肠镜检查，13%（n = 10）进行了SBE。在由资深内镜医师进行结肠镜检查（n = 39）或SBE（n = 10）的49例患者中，盲肠插管率为100%，发现高危息肉的比例为26.5%（n = 13），CRC的比例为4.1%。CT结肠成像分别在22.9%（n = 8）和2.9%（n = 1）的病例中发现了与息肉和CRC一致的结果。6例CT结肠成像怀疑有息肉的患者进一步进行了结肠镜检查，5例患者确诊。
资深内镜医师进行的结肠镜检查在所有患者中均实现了盲肠插管，是结肠镜检查不完全后的一个良好选择。
