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无镇静结肠镜检查中二次前视检查对腺瘤检出率的影响:一项随机对照试验。

Impact of second forward-view examination on adenoma detection rate during unsedated colonoscopy: a randomized controlled trial.

机构信息

China Department of Gastroenterology, Ningbo First Hospital, 59 Liuting St, Ningbo, 315010, Zhejiang, China.

College of Medicine, Ningbo University, Ningbo, 315010, Zhejiang, China.

出版信息

BMC Gastroenterol. 2021 May 10;21(1):213. doi: 10.1186/s12876-021-01783-9.

Abstract

OBJECTIVES

Colorectal cancer on the right side of the colon has been suggested to be harder to detect by colonoscopy. The aim of this study was to evaluate whether a second forward-view examination of the right side of the colon could increase the adenoma detection rate (ADR) and/or polyp detection rate (PDR).

METHODS

This was a single-centre randomized controlled trial. Patients undergoing colonoscopy were recruited and randomly assigned to the second forward-view examination (SFE) group, in which the right side of the colon was examined twice or the traditional colonoscopy (TC) group in which the colonoscopy was performed in a standard manner. The primary outcome was the ADR of right colon. The overall PDR and ADR, PDR of the right colon, per-adenoma miss rate of the right colon, and advanced lesion detection rate were also recorded and compared.

RESULTS

A total of 392 patients were included in the study (SFE group 197 vs. TC group 195). The ADR and PDR of the right colon in the SFE group were significantly higher than those in the TC group (ADR 10.7% vs. 5.1%; P = 0.042); PDR 17.8% vs. 9.7%, P = 0.021). No significant difference was found in overall PDR/ADR, or advanced lesion detection rate between the two groups.

CONCLUSIONS

This prospective controlled study revealed that a second forward-view examination could modestly increase the ADR and PDR of the right colon during unsedated colonoscopies. This simple, safe and time-effective technique might be recommended for routine unsedated colonoscopy.

TRIAL REGISTRATION

Clinical Trials.gov, NCT03619122. Registered on 7/8/2018.

摘要

目的

右侧结肠癌的结肠镜检查较难发现。本研究旨在评估对右侧结肠进行第二次前视检查是否可以提高腺瘤检出率(ADR)和/或息肉检出率(PDR)。

方法

这是一项单中心随机对照试验。招募接受结肠镜检查的患者,并将其随机分配至第二次前视检查(SFE)组或传统结肠镜检查(TC)组。SFE 组对右侧结肠进行两次检查,而 TC 组按标准方式进行结肠镜检查。主要结局是右侧结肠的 ADR。还记录并比较了总 PDR 和 ADR、右半结肠的 PDR、右半结肠的每腺瘤漏诊率和高级病变检出率。

结果

共有 392 例患者纳入研究(SFE 组 197 例,TC 组 195 例)。SFE 组的右半结肠 ADR 和 PDR 明显高于 TC 组(ADR 为 10.7% vs. 5.1%,P=0.042;PDR 为 17.8% vs. 9.7%,P=0.021)。两组之间的总 PDR/ADR 或高级病变检出率无显著差异。

结论

这项前瞻性对照研究显示,在非镇静结肠镜检查中,第二次前视检查可适度提高右侧结肠的 ADR 和 PDR。这种简单、安全且省时的技术可能推荐用于常规非镇静结肠镜检查。

试验注册

ClinicalTrials.gov,NCT03619122。于 2018 年 7 月 8 日注册。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9e6e/8111781/e04276037afe/12876_2021_1783_Fig1_HTML.jpg

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