Sharma V K, Chockalingham S, Clark V, Kapur A, Steinberg E N, Heinzelmann E J, Vasudeva R, Howden C W
Department of Internal Medicine, and WJB Dorn Veterans' Affairs Medical Center, University of South Carolina, Columbia 29203-6808, USA.
Am J Gastroenterol. 1997 May;92(5):809-11.
There is a paucity of data regarding the optimal form of bowel preparation for flexible sigmoidoscopy. Most endoscopists recommend enemas. A simpler preparation that is easy, acceptable, and that reduces patient encounter time would be desirable, and might be cost-effective. Our objective in this study was to evaluate a simple oral form of preparation for screening flexible sigmoidoscopy.
In this randomized, single-blind, controlled trial, we compared two forms of preparation in consecutive male patients referred for screening flexible sigmoidoscopy. The oral preparation consisted of one bottle of magnesium citrate and two "Dulcolax" tablets on the evening before flexible sigmoidoscopy. This was compared with the standard form of preparation, namely, two Fleet's enemas given on arrival at the endoscopy suite. Thirty-seven patients received the oral preparation [mean age, 62.8 +/- 8.9 (SD) yr]; 33 received enemas (mean age, 65.2 +/- 7.3 yr). Endoscopists were blinded to the preparation.
Mean time between arrival and starting flexible sigmoidoscopy was 36 +/- 22 (SD) min for patients on oral preparation, and 62 +/- 25 min for patients receiving enemas (p < 0.0001). Mean times performing flexible sigmoidoscopy were 10 +/- 3 min and 13 +/- 4 min, respectively (p = 0.004). Mean patient satisfaction score (range 0-13) was higher for patients given the oral preparation (11.4 +/- 1.8) than for patients receiving enemas (9.6 +/- 2.4) (p = 0.001). Fifteen patients randomized to receive the oral preparation had previous flexible sigmoidoscopy with an enema preparation; all preferred the oral form. Mean technical difficulty (range 1-10) was 3 +/- 2.2 for patients given the oral preparation and 4.9 +/- 3.1 for patients receiving the enema preparation (p = 0.01). Polyps were identified in 10/37 patients who received the oral preparation and in 3/33 patients who received enemas (p = 0.05). Quality of colon preparation was judged "good" in 29, "fair" in four, and "poor" in four, among the 37 patients given the oral form; corresponding values for 33 patients given enemas were 16, 10, and 7 (p = 0.03).
Patient acceptance, encounter time, technical ease, and quality of colon preparation were significantly better with the oral form of colon preparation than with the standard Fleet enema preparation.
关于乙状结肠镜检查最佳肠道准备方式的数据较少。大多数内镜医师推荐灌肠。一种更简单、易于接受且能减少患者就诊时间的准备方式会是理想的，并且可能具有成本效益。我们这项研究的目的是评估一种用于筛查性乙状结肠镜检查的简单口服准备方式。
在这项随机、单盲、对照试验中，我们比较了连续转诊来接受筛查性乙状结肠镜检查的男性患者的两种准备方式。口服准备方式是在乙状结肠镜检查前一晚服用一瓶枸橼酸镁和两片“杜秘克”片。将其与标准准备方式，即在到达内镜检查室时给予两次福里特灌肠剂进行比较。37名患者接受口服准备方式（平均年龄，62.8±8.9（标准差）岁）；33名患者接受灌肠（平均年龄，65.2±7.3岁）。内镜医师对准备方式不知情。
接受口服准备方式的患者从到达至开始乙状结肠镜检查的平均时间为36±22（标准差）分钟，接受灌肠的患者为62±25分钟（p<0.0001）。进行乙状结肠镜检查的平均时间分别为10±3分钟和13±4分钟（p = 0.004）。接受口服准备方式的患者的平均患者满意度评分（范围0 - 13）（11.4±1.8）高于接受灌肠的患者（9.6±2.4）（p = 0.001）。随机接受口服准备方式的15名患者之前接受过灌肠剂准备的乙状结肠镜检查；他们都更喜欢口服方式。接受口服准备方式的患者的平均技术难度（范围1 - 10）为3±2.2，接受灌肠准备的患者为4.9±3.1（p = 0.01）。接受口服准备方式的37名患者中有10名发现息肉，接受灌肠的33名患者中有3名发现息肉（p = 0.05）。接受口服准备方式的37名患者中，结肠准备质量被判定为“好”的有29名，“一般”的有4名，“差”的有4名；接受灌肠的33名患者的相应数值分别为16、10和7（p = 0.03）。
口服结肠准备方式在患者接受度、就诊时间、操作简便性和结肠准备质量方面明显优于标准的福里特灌肠剂准备方式。
