经内镜肠内管置管中帽辅助结肠镜检查的影响：一项随机对照试验。
Impact of cap-assisted colonoscopy during transendoscopic enteral tubing: A randomized controlled trial.
机构信息
Medical Center for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China.
Department of Spleen and Stomach Diseases, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan 430061, Hubei Province, China.
出版信息
World J Gastroenterol. 2020 Oct 21;26(39):6098-6110. doi: 10.3748/wjg.v26.i39.6098.
BACKGROUND
Colonic transendoscopic enteral tubing (TET) requires double cecal intubation, raising a common concern of how to save cecal intubation time and make the tube stable. We hypothesized that cap-assisted colonoscopy (CC) might reduce the second cecal intubation time and bring potential benefits during the TET procedure.
AIM
To investigate if CC can decrease the second cecal intubation time compared with regular colonoscopy (RC).
METHODS
This prospective multicenter, randomized controlled trial was performed at four centers. Subjects ≥ 7 years needing colonic TET were recruited from August 2018 to January 2020. All subjects were randomly assigned to two groups. The primary outcome was the second cecal intubation time. Secondary outcomes included success rate, insertion pain score, single clip fixation time, purpose and retention time of TET tube, length of TET tube inserted into the colon, and all procedure-related (serious) adverse events.
RESULTS
A total of 331 subjects were randomized to the RC ( = 165) or CC ( = 166) group. The median time of the second cecal intubation was significantly shorter for CC than RC (2.2 min 2.8 min, < 0.001). In patients with constipation, the median time of second cecal intubation in the CC group ( = 50) was shorter than that in the RC group ( = 43) (2.6 min 3.8 min, = 0.004). However, no difference was observed in the CC ( = 42) and RC ( = 46) groups of ulcerative colitis patients (2.0 min 2.5 min, = 0.152). The insertion pain score during the procedure in CC ( = 14) was lower than that in RC ( = 19) in unsedated colonoscopy (3.8 ± 1.7 5.4 ± 1.9; = 0.015). Multivariate analysis revealed that only CC (odds ratio [OR]: 2.250, 95% confidence interval [CI]: 1.161-4.360; = 0.016) was an independent factor affecting the second cecal intubation time in difficult colonoscopy. CC did not affect the colonic TET tube's retention time and length of the tube inserted into the colon. Moreover, multivariate analysis found that only endoscopic clip number (OR: 2.201, 95%CI: 1.541-3.143; < 0.001) was an independent factor affecting the retention time. Multiple regression analysis showed that height (OR: 1.144, 95%CI: 1.027-1.275; = 0.014) was the only independent factor influencing the length of TET tube inserted into the colon in adults.
CONCLUSION
CC for colonic TET procedure is a safe and less painful technique, which can reduce cecal intubation time.
背景
经内镜结肠置管术（TET）需要双盲肠插管，这引起了人们对如何节省盲肠插管时间并使管子稳定的普遍关注。我们假设帽辅助结肠镜检查（CC）可能会减少第二次盲肠插管时间，并在 TET 过程中带来潜在的益处。
目的
研究 CC 是否可以比常规结肠镜检查（RC）缩短第二次盲肠插管时间。
方法
这是一项在四个中心进行的前瞻性多中心随机对照试验。2018 年 8 月至 2020 年 1 月期间，招募了需要结肠 TET 的年龄≥7 岁的受试者。所有受试者均随机分为两组。主要结局是第二次盲肠插管时间。次要结局包括成功率、插入疼痛评分、单夹固定时间、TET 管的目的和保留时间、TET 管插入结肠的长度以及所有与操作相关的（严重）不良事件。
结果
共有 331 名受试者被随机分配到 RC（n=165）或 CC（n=166）组。CC 组的第二次盲肠插管中位时间明显短于 RC 组（2.2 分钟 2.8 分钟，<0.001）。在便秘患者中，CC 组（n=50）的第二次盲肠插管中位时间短于 RC 组（n=43）（2.6 分钟 3.8 分钟，=0.004）。然而，溃疡性结肠炎患者的 CC（n=42）和 RC（n=46）组之间没有观察到差异（2.0 分钟 2.5 分钟，=0.152）。CC（n=14）的术中插入疼痛评分低于 RC（n=19）（未镇静结肠镜检查时，3.8±1.7 5.4±1.9；=0.015）。多变量分析显示，只有 CC（比值比[OR]：2.250，95%置信区间[CI]：1.161-4.360；=0.016）是影响困难性结肠镜检查中第二次盲肠插管时间的独立因素。CC 不影响 TET 管的保留时间和插入结肠的管长。此外，多变量分析发现，只有内镜夹数量（OR：2.201，95%CI：1.541-3.143；<0.001）是影响保留时间的独立因素。多元回归分析显示，身高（OR：1.144，95%CI：1.027-1.275；=0.014）是影响成人 TET 管插入结肠长度的唯一独立因素。
结论
CC 用于结肠 TET 手术是一种安全且痛苦较小的技术，可缩短盲肠插管时间。
Zotero 插件