AIM: To retrospectively compare previous-day vs splitdose preparation in terms of bowel cleanliness and polyp detection in patients referred for polypectomy. METHODS: Fifty patients underwent two colonoscopies: one di...AIM: To retrospectively compare previous-day vs splitdose preparation in terms of bowel cleanliness and polyp detection in patients referred for polypectomy. METHODS: Fifty patients underwent two colonoscopies: one diagnostic in a private clinic and a second for polypectomy in a University Hospital. The latter procedures were performed within 12 wk of the index ones. Examinations were accomplished by two experienced endoscopists, different in each facility. Twenty-seven patients underwent screening/surveillance colonoscopy, while the rest were symptomatic. Previous day bowel preparation was utilized initially and splitdose for polypectomy. Colon cleansing was evaluated using the Aronchick scale. We measured the number of detected polyps, and the polyp miss rates per-polyp.RESULTS: Excellent/good preparation was reported in 38 cases with previous-day preparation(76%) vs 46 with split-dose(92%), respectively(P = 0.03). One hundred and twenty-six polyps were detected initially and 169 subsequently(P < 0.0001); 88 vs 126 polyps were diminutive(P < 0.0001), 25 vs 29 small(P = 0.048) and 13 vs 14 equal or larger than 10 mm. The miss rates for total, diminutive, small and large polyps were 25.4%, 30.1%, 13.7% and 6.6%, respectively. Multivariate analysis revealed that split-dose preparation was significantly associated(OR, P) with increased number of polyps detected overall(0.869, P < 0.001), in the right(0.418, P = 0.008) and in the left colon(0.452, P = 0.02). CONCLUSION: Split-dose preparation improved colon cleansing, enhanced polyp detection and unmasked significant polyp miss rates.展开更多
背景:降低息肉漏诊率对于降低结直肠癌发病率具有重要意义。目前关于结直肠息肉切除术中再次完成结肠镜检查能否降低息肉漏诊率的研究尚少。目的:探讨在结直肠息肉切除术中再次行全结肠检查对减少息肉漏诊的意义。方法:于2020年1月—202...背景:降低息肉漏诊率对于降低结直肠癌发病率具有重要意义。目前关于结直肠息肉切除术中再次完成结肠镜检查能否降低息肉漏诊率的研究尚少。目的:探讨在结直肠息肉切除术中再次行全结肠检查对减少息肉漏诊的意义。方法:于2020年1月—2021年1月连续招募在宁波大学附属第一医院行择期(发现息肉6个月内)结直肠息肉切除术的患者,于术中再次行结肠镜检查。本次结肠镜检查严格控制肠道清洁度,内镜操作由该院富有经验的内镜医师执行,进镜至回盲部,退镜时间不少于6 min。记录息肉大小、形态、数目和位置,分析漏诊息肉的特征。应用Logistic回归模型分析息肉漏诊的影响因素。结果:共146例符合条件的结直肠息肉患者纳入研究,其中男性86例,女性60例,平均年龄(55.54±10.51)岁。息肉总体漏诊率为27.2%(119/438),漏诊息肉均为直径<10 mm的扁平息肉,<5 mm 92枚,5~9 mm 27枚,约半数分布于左半结肠。首次检查单发和多发息肉患者的漏诊比例差异无统计学意义(58.2%对63.3%,P>0.05)。多因素Logistic回归分析显示非同一操作者(OR=12.289,95%CI:4.245~45.034,P<0.001)和进镜时间(OR=1.009,95%CI:1.001~1.017,P=0.032)为首次结肠镜检查息肉漏诊的独立危险因素。结论:结直肠息肉切除术中再次行结肠镜检查可检出首次结肠镜检查漏诊的息肉。内镜医师的操作经验是息肉漏诊的主要影响因素。展开更多
文摘AIM: To retrospectively compare previous-day vs splitdose preparation in terms of bowel cleanliness and polyp detection in patients referred for polypectomy. METHODS: Fifty patients underwent two colonoscopies: one diagnostic in a private clinic and a second for polypectomy in a University Hospital. The latter procedures were performed within 12 wk of the index ones. Examinations were accomplished by two experienced endoscopists, different in each facility. Twenty-seven patients underwent screening/surveillance colonoscopy, while the rest were symptomatic. Previous day bowel preparation was utilized initially and splitdose for polypectomy. Colon cleansing was evaluated using the Aronchick scale. We measured the number of detected polyps, and the polyp miss rates per-polyp.RESULTS: Excellent/good preparation was reported in 38 cases with previous-day preparation(76%) vs 46 with split-dose(92%), respectively(P = 0.03). One hundred and twenty-six polyps were detected initially and 169 subsequently(P < 0.0001); 88 vs 126 polyps were diminutive(P < 0.0001), 25 vs 29 small(P = 0.048) and 13 vs 14 equal or larger than 10 mm. The miss rates for total, diminutive, small and large polyps were 25.4%, 30.1%, 13.7% and 6.6%, respectively. Multivariate analysis revealed that split-dose preparation was significantly associated(OR, P) with increased number of polyps detected overall(0.869, P < 0.001), in the right(0.418, P = 0.008) and in the left colon(0.452, P = 0.02). CONCLUSION: Split-dose preparation improved colon cleansing, enhanced polyp detection and unmasked significant polyp miss rates.
文摘背景:降低息肉漏诊率对于降低结直肠癌发病率具有重要意义。目前关于结直肠息肉切除术中再次完成结肠镜检查能否降低息肉漏诊率的研究尚少。目的:探讨在结直肠息肉切除术中再次行全结肠检查对减少息肉漏诊的意义。方法:于2020年1月—2021年1月连续招募在宁波大学附属第一医院行择期(发现息肉6个月内)结直肠息肉切除术的患者,于术中再次行结肠镜检查。本次结肠镜检查严格控制肠道清洁度,内镜操作由该院富有经验的内镜医师执行,进镜至回盲部,退镜时间不少于6 min。记录息肉大小、形态、数目和位置,分析漏诊息肉的特征。应用Logistic回归模型分析息肉漏诊的影响因素。结果:共146例符合条件的结直肠息肉患者纳入研究,其中男性86例,女性60例,平均年龄(55.54±10.51)岁。息肉总体漏诊率为27.2%(119/438),漏诊息肉均为直径<10 mm的扁平息肉,<5 mm 92枚,5~9 mm 27枚,约半数分布于左半结肠。首次检查单发和多发息肉患者的漏诊比例差异无统计学意义(58.2%对63.3%,P>0.05)。多因素Logistic回归分析显示非同一操作者(OR=12.289,95%CI:4.245~45.034,P<0.001)和进镜时间(OR=1.009,95%CI:1.001~1.017,P=0.032)为首次结肠镜检查息肉漏诊的独立危险因素。结论:结直肠息肉切除术中再次行结肠镜检查可检出首次结肠镜检查漏诊的息肉。内镜医师的操作经验是息肉漏诊的主要影响因素。
文摘目的探讨结肠镜检查中节段性二次退镜对全结肠、不同肠段息肉检出率(polyp detection rate,PDR)和漏诊率的影响。方法纳入2018年7月至2019年11月在我院内镜中心行结肠镜检查的1000例患者,随机分为节段性二次退镜及常规退镜两组,收集两组的检查资料并进行分析。结果最终纳入研究病例为955例,PDR为32.46%,两组PDR为[(31.73%VS. 33.19%),P=0.630],两组在各肠段PDR差异无统计学意义(P>0.05);两组全结肠息肉病例平均检出息肉数为[(3.04±3.64 VS. 2.06±1.97),P=0.004];右半结肠为[(1.37±0.85 VS. 1.51±1.97),P=0.350];横结肠为[(1.50±0.84VS. 1.64±1.06),P=0.478];左半结肠为[(3.25±3.83 VS. 1.77±1.23),P=0.000]。两组全结肠漏诊率分别为[(12.59%VS.18.28%),P=0.026];右半结肠为[(8.22%VS. 20.31%),P=0.037];横结肠为[(9.33%VS. 10.71%),P=0.773];左半结肠为[(14.34%VS. 20.02%),P=0.047];两组并发症的发生率分别为[(2.30%VS. 1.89%),P>0.05]。结论节段二次退镜及常规退镜的PDR相似,二次退镜可降低肠道息肉的漏诊率,选择节段性二次退镜是必要的。
