Division of Gastroenterology, Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 2 Minsheng Road, Dalin, Chiayi, 62247, Taiwan.
School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan.
Tech Coloproctol. 2022 Jan;26(1):35-44. doi: 10.1007/s10151-021-02537-1. Epub 2021 Oct 27.
Randomized controlled trials (RCTs) have reported that water exchange (WE) produced the highest adenoma detection rate (ADR) but did not evaluate right colon adenoma detection rate (rADR) as a primary outcome and only one of the trials employed blinded colonoscopists. The aim of our study was to determine whether, compared with air insufflation, WE significantly increases rADR and right colon serrated lesion detection rate (rSLDR) and decreases adenoma miss rate (rAMR).
This prospective, double-blind RCT was conducted at a regional hospital in Taiwan between December 2015 and February 2020. Standard WE and air insufflation were performed. After cecal intubation, the second blinded endoscopist examined the right colon and obtained rADR (primary outcome) and rSLDR. Then, the primary colonoscopist reinserted the scope to the cecum with WE in both groups and performed a tandem examination of the right colon to obtain rAMR.
There were 284 patients (50.9% male, mean age 58.9 ± 9.4 years) who were randomized to WE (n = 144) or air insufflation (n = 140). The baseline characteristics were similar. The rADR (34.7% vs. 22.3%, p = 0.025), Boston Bowel Preparation Scale scores (mean, 2.6 ± 0.6vs. 2.2 ± 0.6, p < 0.001), rSLDR (18.1% vs. 7.1%, p = 0.007), and rAMR (31.5% vs. 45.2%, p = 0.038) were significantly different between WE and air insufflation.
The current study demonstrated a significantly higher rADR and rSLDR with the WE method performed by blinded colonoscopists. The impact of the significant findings in this report on the occurrence of interval cancers deserves to be studied.
随机对照试验（RCT）报道称，水交换（WE）产生了最高的腺瘤检出率（ADR），但并未将右半结肠腺瘤检出率（rADR）作为主要结局进行评估，且仅有一项试验采用了盲法结肠镜检查。我们的研究旨在确定与空气注入相比，WE 是否能显著提高 rADR 和右半结肠锯齿状病变检出率（rSLDR），并降低腺瘤遗漏率（rAMR）。
这项前瞻性、双盲 RCT 于 2015 年 12 月至 2020 年 2 月在台湾的一家地区医院进行。标准 WE 和空气注入均被执行。盲法第二内镜医师在盲法检查右半结肠后，获得 rADR（主要结局）和 rSLDR。随后，主要结肠镜医师在 WE 组和空气注入组重新插入内镜至盲肠，对右半结肠进行串联检查，获得 rAMR。
共有 284 例患者（男性占 50.9%，平均年龄 58.9±9.4 岁）被随机分配至 WE 组（n=144）或空气注入组（n=140）。两组的基线特征相似。WE 组和空气注入组的 rADR（34.7% vs. 22.3%，p=0.025）、Boston 肠道准备评分（平均值，2.6±0.6 vs. 2.2±0.6，p<0.001）、rSLDR（18.1% vs. 7.1%，p=0.007）和 rAMR（31.5% vs. 45.2%，p=0.038）差异有统计学意义。
当前研究表明，盲法结肠镜医师使用 WE 方法可显著提高 rADR 和 rSLDR。该报告中显著结果对间期癌发生的影响值得研究。
