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一项为行胶囊结肠镜检查而对低剂量的新结肠清洗程序进行评价的试验性研究

发布日期:2014-1-29 12:40:45 文章来源:ENDOSCOPY 作者次数:1360
    一项为行胶囊结肠镜检查而对低剂量的新结肠清洗程序进行评价的试验性研究

    D. Hartmann1, M. Keuchel2, M. Philipper3, I. M. Gralnek4, R. Jakobs5, F. Hagenmüller6, H. Neuhaus3, J. F. Riemann5, 7

    1德国柏林Sana Klinikum Lichtenberg 内科I

    2德国汉堡市Bethesda Krankenhaus Bergedorf 内科部

    3德国杜塞尔多夫Evangelisches Krankenhaus 内科部

    4以色列海法非卧床医疗服务和肠胃病学以色列理工学院和拉帕波特医学系

    5德国莱茵河畔路德维希港市医院内科部

    6德国汉堡Asklepios Klinik Altona医院第一医学部

    7德国莱茵河畔路德维希港医院早期结肠癌检测Lebensblicke-基金会

    背景与研究目的:结肠胶囊内镜检查(CCE)为内镜下结肠可视化提供了一种可替代方法。目前,一些结肠胶囊内镜检查的肠道清洗方案使用磷酸钠试剂,但这样的清洗方法已引起一些安全性问题。因此,本研究目的是测试一种新型的低剂量的不含磷酸钠的聚乙二醇(PEG)肠制剂的可行性和有效性。

    方法:前26例患者(原清洗过程)接受了PEG加抗坏血酸的结肠清洗方案:患者在胶囊摄入的前一晚和当天早上各服用1L0.75L该溶液。而且患者在胶囊结肠镜检查过程中还额外服用了0.5L PEP 作为补充,而且还可选择服用或不服用0.25 L PEP作为补充。按照中期分析,对随后的24例患者的清洗程序进行了修改,即在胶囊摄入前一早上清洗液的摄入量增至1 L,而且第二次补充(0.25 L)给予提前了1-2小时(修改后的清洗过程)。

    结果:采用原清洗程序与修改后的清洗程序,有83%82%的患者的总体结肠清洗效果良好或极好,这两种方案无任何显著差异(P > 0.05)。在接受CCE检查的49例患者中,有37例患者被发现痔静脉丛,从而我们认为该检查是充分的,这两种CCE清洗程序之间无显著差异。对检测≥6 mm结肠息肉来说,与采用标准光学结肠镜检查相比,胶囊结肠镜的灵敏度和特异性分别为91%95%置信区间为70 % - 98 %)和94%95%置信区间为87 % - 97 %)。

    结论:为进行胶囊结肠镜检查,采用PEP加抗坏血酸清洗结肠,这个程序可使80%以上的患者清洗水平达到充分,充分率为76%,为检测息肉提供了良好的准确性。尤其是对那些不允许使用含磷酸钠制剂的患者来说,该程序可能会被视为一种替代的清洗方法。

     


     

    A pilot study evaluating a new low-volume colon cleansing procedure for capsule colonoscopy

    D. Hartmann1, M. Keuchel2, M. Philipper3, I. M. Gralnek4, R. Jakobs5, F. Hagenmüller6, H. Neuhaus3, J. F. Riemann5, 7

    1Department of Internal Medicine I, SanaKlinikum Lichtenberg,Berlin,Germany

    2Department of Internal Medicine,BethesdaKrankenhaus Bergedorf,Hamburg,Germany

    3Department of Internal Medicine, Evangelisches Krankenhaus,Düsseldorf,Germany

    4Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Departments of Ambulatory Care Services and Gastroenterology,Haifa,Israel

    5Department of Internal Medicine C, Klinikum der StadtLudwigshafen,LudwigshafenamRhein,Germany

    61st Medical Department, AsklepiosKlinik Altona,Hamburg,Germany

    7Lebensblicke-Foundation for Early Detection of colorectal cancer, Klinikum Ludwigshafen,LudwigshafenamRhein,Germany

    Background and study aims: Coloncapsule endoscopy (CCE) offers an alternative approach for endoscopic visualization of the colon. Some of the current CCE bowel cleansing regimens use sodium phosphate, which has raised safety concerns. Therefore, the aim of the current study was to test the feasibility and efficacy of a new low-volume, sodium phosphate-free polyethylene glycol (PEG) bowel preparation.

    Methods: The first 26 patients (original cleansing procedure) received a colon cleansing regimen of PEG plus ascorbic acid: patients drank1 Lin the evening and0.75 Lin the morning before capsule ingestion. Patients also drank an additional0.5 LPEG boost and an optional0.25 LPEG boost during the capsule procedure. Following an interim analysis, the cleansing procedure of the subsequent 24 patients was modified, with the morning intake before capsule ingestion being increased to1 L, as well as the second boost (0.25 L) being administered 1 - 2 hours earlier (modified cleansing procedure).

    Results: The overall colon cleanliness was considered to be good or excellent in 83 % (original cleansing procedure) and 82 % (modified cleansing procedure) of patients, without any significant difference between regimens (P > 0.05). In 37 /49 (76 %) of the CCE procedures, the hemorrhoidal plexus was identified and thus the examination was considered complete, with no significant differences between the two CCE cleansing procedures. The capsule sensitivity and specificity for detecting colonic polyps ≥6 mmwere 91 % (95 %CI 70 % - 98 %) and 94 % (95 %CI 87 % - 97 %), respectively, compared with standard optical colonoscopy.

    Conclusion: A colon cleansing procedure using PEG + ascorbic acid for capsule colonoscopy yielded an adequate cleansing level in > 80 % of patients, a completion rate of 76 %, and good accuracy for detecting polyps. This procedure may be considered as an alternative, particularly for patients in whom sodium phosphate-based preparations are contraindicated.

     

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