Popovic Dusan Dj, Filipovic Branka
Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia.
Department of Gastroenterology and Hepatology, Clinic for Internal Medicine, University Clinical Hospital Center "Dr. Dragisa Misovic-Dedinje", Belgrade 11000, Serbia.
World J Gastrointest Endosc. 2024 May 16;16(5):244-249. doi: 10.4253/wjge.v16.i5.244.
Constipation is a significant sociomedical problem, which can be caused by various reasons. In the diagnostic approach to patients with constipation, the following data are usually sufficient: History, complete physical examination (including rectal examination), and additional diagnostic tests. A colonoscopy is not a necessary diagnostic method for all patients with constipation. However, if patients have alarm symptoms/signs, that suggest an organic reason for constipation, a colonoscopy is necessary. The most important alarm symptoms/signs are age > 50 years, gastrointestinal bleeding, new-onset constipation, a palpable mass in the abdomen and rectum, weight loss, anemia, inflammatory bowel disease, and family history positive for colorectal cancer. Most endoscopists do not like to deal with patients with constipation. There are two reasons for this, namely the difficulty of endoscopy and the adequacy of preparation. Both are adversely affected by constipation. To improve the quality of colonoscopy in these patients, good examination techniques and often more extensive preparation are necessary. Good colonoscopy technique implies adequate psychological preparation of the patient, careful insertion of the endoscope with minimal insufflation, and early detection and resolution of loops. Bowel preparation for colonoscopy often requires prolonged preparation and sometimes the addition of other laxatives.
便秘是一个重大的社会医学问题，可由多种原因引起。在对便秘患者的诊断过程中，以下数据通常就足够了：病史、全面的体格检查（包括直肠检查）以及其他诊断性检查。结肠镜检查并非对所有便秘患者都是必要的诊断方法。然而，如果患者有警示症状/体征，提示便秘存在器质性原因，则有必要进行结肠镜检查。最重要的警示症状/体征包括年龄>50岁、胃肠道出血、新发便秘、腹部和直肠可触及肿块、体重减轻、贫血、炎症性肠病以及结直肠癌家族史阳性。大多数内镜医师不喜欢处理便秘患者。原因有两个，即内镜检查难度和准备工作的充分性。这两方面都会因便秘而受到不利影响。为提高这些患者的结肠镜检查质量，需要良好的检查技术以及通常更为广泛的准备工作。良好的结肠镜检查技术意味着要让患者做好充分的心理准备，在内镜插入过程中小心操作，尽量减少充气，并尽早发现和解决肠袢问题。结肠镜检查的肠道准备通常需要较长时间的准备，有时还需添加其他泻药。
