Cheng Chi-Liang, Tang Jui-Hsiang, Hsieh Yu-Hsi, Kuo Yen-Lin, Fang Kuan-Chieh, Tseng Chih-Wei, Su I-Chia, Chang Chun-Chao, Tsui Yi-Ning, Lee Bai-Ping, Zou Ke-Yun, Lee Yun-Shien, Leung Felix W
Division of Gastroenterology, Evergreen General Hospital, Taoyuan, Taiwan.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Am J Gastroenterol. 2024 Oct 30;120(7):1615-1623. doi: 10.14309/ajg.0000000000003168.
Postcolonoscopy colorectal cancers primarily occur in the right-sided colon because of missed adenomas and serrated polyps (SPs). Water exchange (WE) improves cleanliness and visibility of the right-sided colon. We hypothesized that WE could reduce the right-sided colon adenoma (rAMR) and SP miss rate (rSPMR) compared with standard colonoscopy.
We randomly assigned 386 colonoscopy patients to insertion with either WE or CO 2 insufflation. During the first withdrawal, polypectomies were performed up to the hepatic flexure. A second endoscopist, blinded to the insertion technique, re-examined the right-sided colon. The miss rate was determined by dividing the number of additional adenomas or SPs by the total number detected in both examinations. The primary outcome was the combined rAMR and rSPMR.
WE significantly decreased the combined rAMR and rSPMR (22.2% vs 32.2%, P < 0.001) and rSPMR alone (22.5% vs 37.1%, P = 0.002) compared with CO 2 insufflation, but not rAMR (21.8% vs 29.8%, P = 0.079). In addition, WE significantly increased the detection of SP per colonoscopy (SP per colonoscopy) in the right-sided colon (0.95 ± 1.56 vs 0.50 ± 0.79, P < 0.001). Multivariate logistic regression analysis showed that ≥2 SPs in the right-sided colon were an independent predictor of rSPMR (odds ratio, 3.47; 95% confidence interval, 1.89─6.38), along with a higher right-sided colon Boston Bowel Preparation Scale score (odds ratio, 0.55; 95% confidence interval, 0.32─0.94).
The significant reduction in rSPMR and increase in right-sided colon SP per colonoscopy suggest that colonoscopy insertion using WE is a valid alternative to CO 2 insufflation (clinical trial registration number: NCT04124393).
由于腺瘤和锯齿状息肉（SPs）的漏诊，结肠镜检查后结直肠癌主要发生在右侧结肠。水交换（WE）可改善右侧结肠的清洁度和可视性。我们假设与标准结肠镜检查相比，WE可降低右侧结肠腺瘤（rAMR）和SP漏诊率（rSPMR）。
我们将386例结肠镜检查患者随机分为采用WE插入或二氧化碳充气插入两组。在首次退镜过程中，直至肝曲处进行息肉切除术。另一位对插入技术不知情的内镜医师对右侧结肠进行再次检查。漏诊率通过将额外发现的腺瘤或SPs数量除以两次检查中检测到的总数来确定。主要结局是rAMR和rSPMR的合并率。
与二氧化碳充气相比，WE显著降低了rAMR和rSPMR的合并率（22.2%对32.2%，P<0.001）以及单独的rSPMR（22.5%对37.1%，P = 0.002），但未降低rAMR（21.8%对29.8%，P = 0.079）。此外，WE显著增加了右侧结肠每次结肠镜检查中SPs的检出率（右侧结肠每次结肠镜检查的SPs）（0.95±1.56对0.50±0.79，P<0.001）。多因素逻辑回归分析显示，右侧结肠≥2个SPs是rSPMR的独立预测因素（比值比，3.47；95%置信区间，1.89─6.38），同时右侧结肠波士顿肠道准备量表评分较高也是预测因素（比值比，0.55；95%置信区间，0.32─0.94）。
rSPMR的显著降低以及右侧结肠每次结肠镜检查中SPs检出率的增加表明，采用WE进行结肠镜插入是二氧化碳充气的有效替代方法（临床试验注册号：NCT04124393）。
