Tumino Emanuele, Visaggi Pierfrancesco, Bolognesi Valeria, Ceccarelli Linda, Lambiase Christian, Coda Sergio, Premchand Purushothaman, Bellini Massimo, de Bortoli Nicola, Marciano Emanuele
Endoscopy Unit, Azienda Ospedaliero Universitaria Pisana, 56125 Pisa, Italy.
Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56100 Pisa, Italy.
Diagnostics (Basel). 2023 Jul 23;13(14):2452. doi: 10.3390/diagnostics13142452.
Lower gastrointestinal endoscopy is considered the gold standard for the diagnosis and removal of colonic polyps. Delays in colonoscopy following a positive fecal immunochemical test increase the likelihood of advanced adenomas and colorectal cancer (CRC) occurrence. However, patients may refuse to undergo conventional colonoscopy (CC) due to fear of possible risks and pain or discomfort. In this regard, patients undergoing CC frequently require sedation to better tolerate the procedure, increasing the risk of deep sedation or other complications related to sedation. Accordingly, the use of CC as a first-line screening strategy for CRC is hampered by patients' reluctance due to its invasiveness and anxiety about possible discomfort. To overcome the limitations of CC and improve patients' compliance, several studies have investigated the use of robotic colonoscopy (RC) both in experimental models and in vivo. Self-propelling robotic colonoscopes have proven to be promising thanks to their peculiar dexterity and adaptability to the shape of the lower gastrointestinal tract, allowing a virtually painless examination of the colon. In some instances, when alternatives to CC and RC are required, barium enema (BE), computed tomographic colonography (CTC), and colon capsule endoscopy (CCE) may be options. However, BE and CTC are limited by the need for subsequent investigations whenever suspicious lesions are found. In this narrative review, we discussed the current clinical applications of RC, CTC, and CCE, as well as the advantages and disadvantages of different endoscopic procedures, with a particular focus on RC.
下消化道内镜检查被认为是诊断和切除结肠息肉的金标准。粪便免疫化学检测呈阳性后延迟进行结肠镜检查会增加晚期腺瘤和结直肠癌（CRC）发生的可能性。然而，患者可能因担心潜在风险以及疼痛或不适而拒绝接受传统结肠镜检查（CC）。在这方面，接受CC检查的患者经常需要镇静以更好地耐受该检查过程，这增加了深度镇静或其他与镇静相关并发症的风险。因此，由于其侵入性以及患者对可能不适的担忧，CC作为CRC一线筛查策略的应用受到阻碍。为了克服CC的局限性并提高患者的依从性，多项研究在实验模型和体内研究了机器人结肠镜检查（RC）的应用。自推进式机器人结肠镜因其独特的灵活性和对下消化道形状的适应性已被证明具有前景，可实现几乎无痛的结肠检查。在某些情况下，当需要CC和RC的替代方法时，钡剂灌肠（BE）、计算机断层结肠成像（CTC）和结肠胶囊内镜检查（CCE）可能是选择。然而，BE和CTC的局限性在于，每当发现可疑病变时都需要后续检查。在这篇叙述性综述中，我们讨论了RC、CTC和CCE的当前临床应用，以及不同内镜检查程序的优缺点，特别关注了RC。
