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在内镜插入和撤出过程中还是仅在撤出过程中行结直肠息肉切除术?一项随机性对照试验

发布日期:2014-1-29 12:40:59 文章来源:GIE 作者次数:4586
    1瑞士,苏伊士,苏伊士大学医院,肠胃与肝脏学部

    2瑞士,卢塞恩,圣安娜艾瑞丝艾兰德门诊部,肠胃与肝脏学部

    3瑞士,洛桑大学,沃州大学中心医院,肠胃与肝脏病学部

    4瑞士,苏伊士,Triemli医院,肠胃与肝脏学部

    5瑞士,伯尔尼大学,社会与预防医学学院

     

    背景与研究目的:常规的结直肠息肉切除术都是在内镜撤出过程中实施的。但是,在内镜插入过程中检测到的息肉可能会在撤出的过程中被错过。我们的目的是评估:与只在内窥镜撤出过程中实施息肉切除术相比,在内镜插入和撤出过程中均实施是否会增加息肉检查的准确率和切除率,同时对两种方法的手术时间进行评定。

    患者和方法:这项研究包括初次被检查出息肉的患者,这些患者被随机划分为两组;A组中,大于或等于10毫米的息肉在结肠镜插入和撤出的过程中被切除,B组中,息肉只在撤出的过程中被切除。主要测量指标为:结肠镜检查时间;插入过程中检测到的息肉数量,而不是撤出过程中发现的;操作难易度;病患不适感和并发症。

    研究结果:150例患者被随机分配到A组,151例患者被分配到了B组。两组的平均(±标准偏差[SD])结肠镜检查时间基本相同(A组为30.8± 15.6分钟,B组为28.5 ± 13.8分钟,P=0.176)。A组中有387处息肉被发现且切除(平均每次结肠镜手术切除2.58处);B组中,有389颗息肉(平均每次结肠镜手术发现2.58处息肉)被发现,而只有376处被切除(13颗息肉被遗漏,平均直径[标准变差]3.2[1.3]毫米;即7.3%的患者)。两组患者的耐受性基本相同。

    结论:仅在内镜撤出过程中切除大于或等于10毫米的息肉往往伴随着相当大的遗漏几率。因此,我们建议在内镜插入和撤出过程中均实施切除手术。


    Colorectal polypectomy during insertion and withdrawal or only during withdrawal? A randomized controlled trial

    S. M. Wildi1, 2, *, A. M. Schoepfer3, *, S. R. Vavricka1, 4, H. Fruehauf1, 4, E. Safroneeva5, N. Wiegand1, 2, P. Bauerfeind1, M. Fried1

    1Division of Gastroenterology and Hepatology, University HospitalofZurich, ZurichSwitzerland

    2Division of Gastroenterology and Hepatology, Hirslanden Clinic St. Anna, Lucerne,Switzerland

    3Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois,University of Lausanne,Switzerland

    4Division of Gastroenterology and Hepatology, Department of Internal Medicine, Triemlispital,Zurich,Switzerland

    5Institute of Social and Preventive Medicine,University of Bern,Switzerland

    *         Abstract

    Background and study aims: Removal of colorectal polyps is routinely performed during withdrawal of the endoscope. However, polyps detected during insertion of the colonoscope may be missed at withdrawal. We aimed to evaluate whether polypectomy during both insertion and withdrawal increases polyp detection and removal rates compared with polypectomy at withdrawal only, and to assess the duration of both approaches.

    Patients and methods: Patients were included into the study when the first polyp was detected, and randomized into two groups; in group A, polyps ≤10 mmin diameter were removed during insertion and withdrawal of the colonoscope, while in group B, these polyps were removed at withdrawal only. Main outcome measures were duration of colonoscopy, number of polyps detected during insertion but not recovered during withdrawal, technical ease, patient discomfort, and complications.

    Results: 150 patients were randomized to group A and 151 to group B. Mean (± standard deviation [SD]) duration of colonoscopy did not differ between the groups (30.8 ± 15.6 min [A] vs. 28.5 ± 13.8 min [B], P = 0.176). In group A 387 polyps (mean 2.58 per colonoscopy) were detected and removed compared with 389 polyps detected (mean 2.58 per colonoscopy) in group B of which 376 were removed (13 polyps were missed, mean size [SD] 3.2 [1.3] mm; 7.3 % of patients). Patient tolerance was similar in the two groups.

    Conclusions: Removal of polyps ≤10 mmduring withdrawal only is associated with a considerable polyp miss rate. We therefore recommend that these polyps are removed during both insertion and withdrawal.

     

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