中肠置管后肠道准备提高了克罗恩病磁共振小肠造影的有效性和依从性：一项随机对照试验
Bowel preparation after mid-gut tubing enhanced the efficacy and compliance of magnetic resonance enterography in Crohn's disease: a randomized controlled trial.
作者信息
Wang Yun, Dai Min, Zheng Minghui, Jin Yan, Wen Quan, Cui Bota, Zhang Zulun, Zhu Jianguo, Zhang Faming
机构信息
Department of Microbiota Medicine and Medical Center for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Key Lab of Holistic Integrative Enterology, Nanjing Medical University, Nanjing, China.
出版信息
Therap Adv Gastroenterol. 2024 Sep 26;17:17562848241275337. doi: 10.1177/17562848241275337. eCollection 2024.
BACKGROUND
Magnetic resonance enterography (MRE) has become a routine intestinal imaging examination for Crohn's disease (CD). Sufficient bowel preparation is fundamental for MRE.
OBJECTIVES
To compare the efficacy and compliance of bowel preparation between through a mid-gut tube and oral administration for MRE in CD.
DESIGN
This was an open-label, prospective, multicenter, randomized controlled trial.
METHODS
Eligible patients were randomized at a 1:1 ratio into an oral group (bowel preparation by oral administration) and a tubing group (bowel preparation through a mid-gut tube). Bowel preparation for MRE included bowel cleaning and bowel distention. The primary outcomes were the degree of discomfort and grade of bowel distention. The secondary outcomes were diagnostic accuracy rate through MRE, mental stress, and bowel preparation method preference.
RESULTS
A total of 95 CD patients were included in the final analysis. Subjects in the tubing group complained of less vomiting during bowel preparation than those in the oral group ( < 0.05). The degree of nausea and bloating during bowel cleaning for MRE was lower in the tubing group than in the oral group (all < 0.05). The distention grade was higher in the tubing group compared to the oral group in the splenic flexure of the colon and rectosigmoid colon. The tubing group demonstrated a higher overall diagnostic sensitivity in ulcers compared to the oral group ( = 0.048). Additionally, bowel preparation via the mid-gut tube ameliorated mental stress ( = 0.020) and increased bowel preparation preference ( < 0.001).
CONCLUSION
Bowel preparation through the mid-gut tube enhanced the efficacy and compliance for MRE in CD. This study highlighted the concept of physician-patient satisfaction using mid-gut tube for proper bowel preparation for MRE, enteral nutrition and microbial therapy.
TRIAL REGISTRATION
ClinicalTrials.gov, NCT03541733, registered 5 May 2018.
背景
磁共振小肠造影（MRE）已成为克罗恩病（CD）的常规肠道成像检查。充分的肠道准备是MRE的基础。
目的
比较经中肠管和口服进行肠道准备用于CD患者MRE检查的有效性和依从性。
设计
这是一项开放标签、前瞻性、多中心、随机对照试验。
方法
符合条件的患者按1:1比例随机分为口服组（通过口服进行肠道准备）和置管组（通过中肠管进行肠道准备）。MRE的肠道准备包括肠道清洁和肠道扩张。主要结局为不适程度和肠道扩张分级。次要结局为MRE的诊断准确率、精神压力和肠道准备方法偏好。
结果
最终分析共纳入95例CD患者。置管组患者在肠道准备期间抱怨呕吐的情况少于口服组（<0.05）。置管组MRE肠道清洁期间的恶心和腹胀程度低于口服组（均<0.05）。结肠脾曲和直肠乙状结肠处，置管组的扩张分级高于口服组。与口服组相比，置管组在溃疡方面的总体诊断敏感性更高（=0.048）。此外，经中肠管进行肠道准备可减轻精神压力（=0.020）并增加对肠道准备方法的偏好（<0.001）。
结论
经中肠管进行肠道准备提高了CD患者MRE检查的有效性和依从性。本研究强调了使用中肠管进行适当的肠道准备、肠内营养和微生物治疗以提高医患满意度的概念。
试验注册
ClinicalTrials.gov，NCT03541733，于2018年5月5日注册。
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