吞咽动作干预改善磁控胶囊胃镜食管检查效果的队列研究

The effect of swallowing intervention on improving the esophageal examination by magnetically controlled capsule endoscopy:a cohort study

目的探讨吞咽动作干预对磁控胶囊胃镜(MCE)食管检查效果的影响和可行性,为其临床应用提供理论依据。方法前瞻性纳入2021年1月至2022年5月于四川大学华西医院行MCE检查的被检者196例,根据MCE吞服过程中吞咽动作的不同分为常规检查对照组和吞咽控制干预组各98例。比较两组被检者性别、年龄、吸烟史、饮酒史、体重指数、临床症状(腹痛或腹胀、便血、黑便或粪便隐血试验阳性)、食管通过时间、食管病变检出率等指标。采用Wilcoxon秩和检验和卡方检验进行统计学分析。结果常规检查对照组与吞咽控制干预组年龄、性别、吸烟史、饮酒史、体重指数,糖尿病和高血压的患病情况,以及MCE检查原因比较,差异均无统计学意义(均P>0.05)。所有被检者均顺利完成检查,胶囊均排出体外。吞咽控制干预组的食管通过时间长于常规检查对照组[44.50 s(26.75 s,101.25 s)比11.00 s(5.00 s,29.00 s)],差异有统计学意义(Z=-8.13,P<0.001)。年龄为40~59岁被检者食管通过时间长于年龄<40岁者,但短于年龄≥60岁者[54.00 s(36.25 s,64.75 s)比28.00 s(23.00 s,35.00 s)、69.50 s(64.75 s,73.00 s)],差异均有统计学意义(Z=-6.72、-6.91,均P<0.001)。吞咽控制干预组食管病变检出率高于常规检查对照组[22.4%(22/98)比11.2%(11/98)],差异有统计学意义(χ^(2)=4.41,P=0.036)。结论通过指令控制吞咽动作能有效延长MCE对食管的检查时间,并能提高MCE对食管病变的检出率。

Objective To investigate the effect and feasibility of swallowing intervention on esophageal examination by magnetically controlled gastric capsule endoscope(MCE),and to provide theoretical evidence for clinical application.Methods From January 2021 to May 2022,196 subjects who underwent MCE examination at West China Hospital,Sichuan University were prospectively enrolled.According to the swallowing action during MCE procedure,the subjects were divided into routine examination control group and swallowing-controlled intervention group with 98 cases in each group.The data of gender,age,history of smoking and drinking,body mass index,clinical symptoms(abdominal pain or abdominal distension,hematochezia,melena or positive fecal occult-bloodtest),esophageal transit time of MCE and detection rate of esophageal lesions were compared between the 2 groups.Wilcoxon rank sum test and chi-square test were used for statistical analysis.Results There were no significant differences in age,gender,smoking history,drinking history,body mass index,history of diabetes,history of hypertension,and indication of MCE examination between the routine examination control group and swallowing-controlled intervention group(all P>0.05).All the subjects successfully completed the examination,and the capsules were excreted from the body.The median esophageal transit time of swallowing-controlled intervention group was longer than that of the routine examination control group(44.50 s(26.75 s,101.25 s)vs.11.00 s(5.00 s,29.00 s)),and the difference was statistically significant(Z=-8.13,P<0.001).The esophageal transit time of the patients aged 40 to 59 years old was longer than that of the patients aged<40 years old,but shorter than that of the patients aged≥60 years old(54.00 s(36.25 s,64.75 s)vs.28.00 s(23.00 s,35.00 s)and 69.50 s(64.75 s,73.00 s)),and the differences were statistically significant(Z=-6.72 and-6.91,both P<0.001).The detection rate of esophageal lesions of swallowing-controlled intervention group was higher than that of routine examination control group(22.4%,22/98 vs.11.2%,11/98),and the difference was statistically significant(χ^(2)=4.41,P=0.036).Conclusion Command-controlled swallowing can effectively prolong the time of esophagus examination by MCE,and improve the detection rate of esophageal lesions by MCE.