Williams C B, Macrae F A, Bartram C I
Endoscopy. 1982 May;14(3):74-8. doi: 10.1055/s-2007-1021584.
Three hundred and thirty patients having had previous colonoscopic polypectomy of adenomas were recalled for follow-up and submitted to all available diagnostic methods: occult blood testing, digital examination, rigid proctosigmoidoscopy, fibre-optic sigmoidoscopy, total colonoscopy and double contrast barium enema. Polyps up to 7 mm diameter were electro-coagulated during diagnostic endoscopy but larger polyps were left in situ for barium enema before polypectomy at a later date. Disparities between endoscopy and X-ray were rechecked by one or both procedures. Occult blood testing, digital examination and rigid proctosigmoidoscopy were found to be inaccurate or ineffective in diagnosis of the 37% of patients with further adenomas or carcinomas. Double contrast barium enema demonstrated 71% of larger lesions compared to the 92% shown by colonoscopy. The commonest sites of X-ray inaccuracy were in the sigmoid colon and caecum. Colonoscopy permits immediate electrocoagulation or snare polypectomy of any lesions seen, as well as being the more accurate investigation and is, therefore, the procedure of choice in post polypectomy follow-up. The mean time taken for diagnostic total colonoscopy in this series was 15.3 minutes, comparable to the time taken for barium enema. Postal questionnaire showed both procedures to be equally well tolerated by the patients. Thirty per cent of colonoscopies were, however, considered technically difficult by the endoscopist, and for these patients it is suggested that follow-up should be by the combination of fibre-sigmoidoscopy using carbon dioxide insufflation and immediate double contrast barium enema. Should this combination indicate a need for total colonoscopy, then almost all adenomas and cancers would be detected. Total examination of the colon by one or other means is essential, over half the patients with adenomas and three of the five patients with carcinoma showing no pathology in the territory of fibresigmoidoscopy or limited colonoscopy.
330例曾接受过腺瘤结肠镜息肉切除术的患者被召回进行随访，并接受了所有可用的诊断方法：潜血检测、指诊、硬式直肠乙状结肠镜检查、纤维乙状结肠镜检查、全结肠镜检查和双重对比钡灌肠。直径达7mm的息肉在诊断性内镜检查时进行电凝，但较大的息肉则留待以后息肉切除术前进行钡灌肠时原位保留。内镜检查和X线检查结果的差异通过一种或两种检查方法进行复查。发现潜血检测、指诊和硬式直肠乙状结肠镜检查对于37%有进一步腺瘤或癌的患者诊断不准确或无效。双重对比钡灌肠显示71%的较大病变，而结肠镜检查显示的比例为92%。X线检查不准确最常见的部位是乙状结肠和盲肠。结肠镜检查可对所见的任何病变立即进行电凝或圈套息肉切除术，而且是更准确的检查方法，因此是息肉切除术后随访的首选方法。本系列中诊断性全结肠镜检查的平均用时为15.3分钟，与钡灌肠用时相当。邮寄问卷调查显示患者对这两种检查方法的耐受性相同。然而，内镜医师认为30%的结肠镜检查在技术上有难度，对于这些患者，建议采用二氧化碳充气纤维乙状结肠镜检查和立即双重对比钡灌肠相结合的方法进行随访。如果这种联合检查提示需要进行全结肠镜检查，那么几乎所有的腺瘤和癌症都能被检测出来。通过一种或另一种方法对结肠进行全面检查至关重要，超过一半的腺瘤患者和五分之三的癌患者在纤维乙状结肠镜检查或有限的结肠镜检查范围内未发现病变。
