Department of Thoracic Surgery, The First Hospital of China Medical University, No.155 North Nanjing Street, Shenyang, 110001, People's Republic of China.
Department of Colorectal Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, No. 44 Xiaoheyan Road, Dadong District, Shenyang, 110042, Liaoning Province, People's Republic of China.
Surg Endosc. 2021 Mar;35(3):1171-1181. doi: 10.1007/s00464-020-07483-x. Epub 2020 Mar 3.
Colonoscopies are considered to be the primary screening test and gold standard test for colorectal cancer. Position changes during colonoscope withdrawal are believed to be associated with an increased adenoma detection rate (ADR) and polyp detection rate (PDR). However, previous results conflicted, and this study aimed to elucidate the effectiveness of dynamic position changes during colonoscope withdrawal.
The relevant publications were identified by searching the medical databases. The primary outcomes were the ADR and PDR, which were pooled and analyzed. The secondary outcome was the withdrawal time. The studies that supplied the ADR and PDR for different segments of the colon were separated into subgroup analyses.
Five randomized controlled trials were eligible for analysis. The total ADR was higher with dynamic position changes than with a static position (odds ratio, [OR] 1.34; 95% confidence interval [CI] 1.13-1.59; p < 0.001), with low evidence of between-study heterogeneity (I = 0%). Although the total PDR was slightly higher with dynamic position changes than with a static position (OR 1.23; 95% CI 0.88-1.73), there difference was not statistically significant (p = 0.22). The withdrawal time was only increased by 0.47 min (95% CI - 0.11 to 1.06) with dynamic position changes, without statistical significance (p = 0.11). The subgroup analysis showed that the ADR and PDR for the transverse colon were higher with dynamic position changes, with pooled estimates of ADR (OR 1.72; 95% CI 1.02-2.88; p = 0.04) and PDR (OR 1.79; 95% CI 1.08-2.96; p = 0.02).
Dynamic position changes during colonoscope withdrawal increased the total ADR; however, no obvious increase was found in the total PDR. The withdrawal time was not significantly prolonged with dynamic position changes. Subgroup analysis showed that the ADR and PDR in the transverse colon were obviously improved with dynamic position changes.
结肠镜检查被认为是结直肠癌的主要筛查试验和金标准试验。人们认为，在结肠镜退镜过程中改变体位与腺瘤检出率（ADR）和息肉检出率（PDR）的增加有关。然而，之前的研究结果存在冲突，本研究旨在阐明结肠镜退镜过程中动态体位改变的有效性。
通过检索医学数据库来确定相关的出版物。主要结果是 ADR 和 PDR，对其进行汇总和分析。次要结果是退镜时间。对于提供不同结肠段 ADR 和 PDR 的研究，将其分为亚组分析。
有 5 项随机对照试验符合分析条件。与静态体位相比，动态体位变化时总 ADR 更高（优势比 [OR] 1.34；95%置信区间 [CI] 1.13-1.59；p<0.001），且研究间异质性较低（I=0%）。虽然动态体位变化时总 PDR 略高于静态体位（OR 1.23；95% CI 0.88-1.73），但差异无统计学意义（p=0.22）。与静态体位相比，动态体位变化仅使退镜时间增加 0.47 分钟（95% CI -0.11 至 1.06），差异无统计学意义（p=0.11）。亚组分析显示，动态体位变化时横结肠的 ADR 和 PDR 更高，汇总估计的 ADR（OR 1.72；95% CI 1.02-2.88；p=0.04）和 PDR（OR 1.79；95% CI 1.08-2.96；p=0.02）。
在结肠镜退镜过程中改变体位可增加总 ADR，但总 PDR 无明显增加。动态体位改变并未显著延长退镜时间。亚组分析显示，横结肠的 ADR 和 PDR 明显改善。
