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水辅助结肠镜检查:系统性评价

发布日期:2014-1-29 12:40:55 文章来源:ENDOSCOPY 作者次数:1496

    背景

    水辅助结肠镜检查是以撤消注水的时机为特征,主要是在撤消(水浸泡)或插入(水交换)期间。

    目的

    讨论这些方法在结肠镜检查疼痛和腺瘤检测率(ADR)的影响。

    设计

    系统性评价。

    环境

    比较在结肠镜插入过程中采用水辅助法和注气法的随机对照试验(RCT)。

    患者

    接受结肠镜检查的患者。

    干预

    考虑Medline、文献服务检索系统和谷歌搜索(20081-201112月)和新闻发布会上个人通信的手稿,以确定合适的RCTs

    主要测试结果

    结肠镜检查期间疼痛和ADR。根据是否使用水浸润或水交换来对RCTs进行分组。根据分组情况对报告的疼痛评分和ADR进行列表。

    结果

    与传统的注气法相比,通过水浸泡和水交换进行结肠镜检查时的疼痛明显减轻。与水浸泡相比,采用水交换可定性降低疼痛评分。在采用水浸润时我们观察到ADR增加和减少的混合模式。实施水交换时所得ADR较高,尤其在结肠脾曲近端。

    局限性

    报告中的差异限制了荟萃分析的应用。不能使结肠镜医师事先不知情,进而可导致观测结果有不明确的偏见。

    结论

    与注气法相比,水浸泡和水交换显著降低结肠镜检查的痛苦。在减低结肠镜检查不适和增加ADR方面,水交换要比水浸泡效果更好。这3种方法逐一比较是有必要的。

    缩写词ADR,腺瘤检出率;PEG,聚乙二醇;RCT,随机对照试验


     

    Water-aided colonoscopy: a systematic review

    Received 4 November 2011; accepted 25 April 2012.

    Background

    Water-aided methods for colonoscopy are distinguished by the timing of removal of infused water, predominantly during withdrawal (water immersion) or during insertion (water exchange).

    Objective

    To discuss the impact of these approaches on colonoscopy pain and adenoma detection rate (ADR).

    Design

    Systematic review.

    Setting

    Randomized, controlled trial (RCT) that compared water-aided methods and air insufflation during colonoscope insertion.

    Patients

    Patients undergoing colonoscopy.

    Intervention

    Medline, PubMed, and Google searches (January 2008-December 2011) and personal communications of manuscripts in press were considered to identify appropriate RCTs.

    Main Outcome Measurements

    Pain during colonoscopy and ADR. RCTs were grouped according to whether water immersion or water exchange was used. Reported pain scores and ADR were tabulated based on group assignment.

    Results

    Pain during colonoscopy is significantly reduced by both water immersion and water exchange compared with traditional air insufflation. The reduction in pain scores was qualitatively greater with water exchange as compared with water immersion. A mixed pattern of increases and decreases in ADR was observed with water immersion. A higher ADR, especially proximal to the splenic flexure, was obtained when water exchange was implemented.

    Limitations

    Differences in the reports limit application of meta-analysis. The inability to blind the colonoscopists exposed the observations to uncertain bias.

    Conclusion

    Compared with air insufflation, both water immersion and water exchange significantly reduce colonoscopy pain. Water exchange may be superior to water immersion in minimizing colonoscopy discomfort and in increasing ADR. A head-to-head comparison of these 3 approaches is required.

    Abbreviations:  ADR, adenoma detection rate , PEG, polyethylene glycol , RCT, randomized, controlled trial

     

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