等剂量西甲硅油乳剂口服或直接肠内注入对肠镜视野清晰度的影响
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摘要
目的探讨等剂量西甲硅油乳剂口服或直接肠内注入对肠镜视野清晰度的影响。方法选择2016年5月-2017年5月在我院内镜中心接受肠镜检查的100例患者作为研究对象,随机分成2组,每组50例。在常规口服导泻药进行肠道准备的基础上,对照组在肠镜检查前4 h口服西甲硅油乳剂30 ml,实验组将西甲硅油乳剂30 ml溶于500 ml 0.9%氯化钠注射液,在进镜过程中直接注入肠道,比较两组患者的肠道清洁度、肠腔内气泡量以及息肉检出率。结果实验组和对照组清晰视野所占的比例分别为84%和64%,实验组祛泡效果优于对照组(P=0.023),两组患者的肠道清洁度(72%vs 76%)和息肉检出率(46%vs 32%)无统计学差异(P均>0.05)。结论西甲硅油乳剂稀释后直接肠内注入的祛泡效果优于等剂量口服给药,能提供更为清晰的检查视野,值得临床推广和应用。
Objective To explore the effect of oral administration versus direct enteral injection of same dose of simethicone emulsion on mucosal visualization at colonoscopy. Methods One hundred patients who underwent colonoscopy in our hospital from May 2016 to May 2017 were enrolled in the study, and they were randomly divided into two groups with 50 cases in each group. Patients in the control group received oral administration of 30 mL of simethicone emulsion at 4 hours before examination, and in the experimental group, 30 mL of simethicone emulsion was dissolved in 500 mL of normal saline and injected into the intestine directly. The bowel cleanliness, mucosal visibility score and the detection rate of polyp were compared between two groups. Results Overall cleansing(excellent or good) quality was significantly higher in the observation group compared to control group(84% vs 64%,P =0.023). The effect of eliminating foam and bubbles in the observation group was better than that in the control group. There was no significant difference in bowel cleanliness(72% vs 76%) and detection rate of polyp in the intestine(46% vs 32%) between the two groups(P > 0.05, respectively). Conclusion Simethicone emulsion diluting directly into the intestine can provide a clearer inspection field compared to oral administration of the same dose, which is worthy of clinical application.
Objective To explore the effect of oral administration versus direct enteral injection of same dose of simethicone emulsion on mucosal visualization at colonoscopy. Methods One hundred patients who underwent colonoscopy in our hospital from May 2016 to May 2017 were enrolled in the study, and they were randomly divided into two groups with 50 cases in each group. Patients in the control group received oral administration of 30 mL of simethicone emulsion at 4 hours before examination, and in the experimental group, 30 mL of simethicone emulsion was dissolved in 500 mL of normal saline and injected into the intestine directly. The bowel cleanliness, mucosal visibility score and the detection rate of polyp were compared between two groups. Results Overall cleansing(excellent or good) quality was significantly higher in the observation group compared to control group(84% vs 64%,P =0.023). The effect of eliminating foam and bubbles in the observation group was better than that in the control group. There was no significant difference in bowel cleanliness(72% vs 76%) and detection rate of polyp in the intestine(46% vs 32%) between the two groups(P > 0.05, respectively). Conclusion Simethicone emulsion diluting directly into the intestine can provide a clearer inspection field compared to oral administration of the same dose, which is worthy of clinical application.
引文
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14 Parmar R,Martel M,Rostom A,et al.Validated Scales for Colon Cleansing:A Systematic Review[J].Am J Gastroenterol,2016,111(2):197-204.
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16 ASGE Standards of Practice Committee,Saltzman JR,Cash BD,et al.Bowel preparation before colonoscopy[J].Gastrointest Endosc,2015,81(4):781-794.
17 赵莉,许乐,刚锐,等.复方聚乙二醇电解质散对老年患者肠道准备效果的随机对照研究[J].中华消化内镜杂志,2015,32(3):164-166.
18 Song M,Kwek AB,Law NM,et al.Efficacy of small-volume simethicone given at least 30 min before gastroscopy[J].World J Gastrointest Pharmacol Ther,2016,7(4):572-578.
19 Kim HG,Jeon SR,Kim MY,et al.How to predict adequate bowel preparation before colonoscopy using conventional polyethylene glycol:prospective observational study based on survey[J].Dig Endosc,2015,27(1):87-94.
20 顾勇,李娜,崔海斌,等.结肠镜检查肠道准备四种方法效果比较[J].武警医学,2015,26(8):805-807.
21 Yeo SH,Kwak JH,Kim YU,et al.Comparative Study on Bowel Preparation Efficacy of Ascorbic Acid Containing Polyethylene Glycol by Adding Either Simethicone or 1 L of Water in Health Medical Examination Patients:A Prospective Randomized Controlled Study[J].Korean J Gastroenterol,2016,67(4):189-197.
22 Elvas L,Areia M,Brito D,et al.Premedication with simethicone and N-acetylcysteine in improving visibility during upper endoscopy:a double-blind randomized trial[J].Endoscopy,2017,49(2):139-145.
23 Leung WK,Lo OS,Liu KS,et al.Detection of colorectal adenoma by narrow band imaging(HQ190)vs.high-definition white light colonoscopy:a randomized controlled trial[J].Am J Gastroenterol,2014,109(6):855-63.
2 Martin D,Walayat S,Ahmed Z,et al.Impact of bowel preparation type on the quality of colonoscopy:a multicenter community-based study[J].J Community Hosp Intern Med Perspect,2016,6(2):31074.
3 Gordon M,Karlsen F,Isaji S,et al.Bowel preparation for elective procedures in children:a systematic review and meta-analysis[J].Bmj Paediatr Open,2017,1(1):e000118.
4 Tajika M,Tanaka T,Ishihara M,et al.Optimal intake of clear liquids during preparation for afternoon colonoscopy with low-volume polyethylene glycol plus ascorbic acid[J].Endosc Int Open,2017,5 (6):E416-E423.
5 Rebecca M,Keegan T,Constantine D,et al.The Effect on Colon Visualization During Colonoscopy of the Addition of Simethicone to Polyethylene Glycol-Electrolyte Solution:A Randomized SingleBlind Study[J].Clin Transl Gastroenterol,2012,3(11):e26.
6 Zhou J,Tang X,Jing W,et al.Feasibility of a novel low-volume and sodium phosphate-free bowel preparation regimen for colon capsule endoscopy[J].Exp Ther Med,2017,14(2):1739-1743.
7 Zhang S,Zheng D,Wang J,et al.Simethicone improves bowel cleansing with low-volume polyethylene glycol:a multicenter randomized trial[J].Endoscopy,2017,50(4):412-422.
8 Zorzi M,Valiante F,GermanàB,et al.Comparison between different colon cleansing products for screening colonoscopy.A noninferiority trial in population-based screening programs in Italy[J].Endoscopy,2016,48(3):223-231.
9 Basford PJ,Brown J,Gadeke L,et al.A randomized controlled trial of pre-procedure simethicone and N-acetylcysteine to improve mucosal visibility during gastroscopy-NICEVIS[J].Endosc Int Open,2016,4(11):E1197-E1202.
10 Van Stiphout SH,Laros IF,Van Wezel RA,et al.Crystallization in the waterjet channel in colonoscopes due to simethicone[J].Endoscopy,2016,48(S1):E394.
11 丁黎葭,占强.二甲硅油散不同给药途径在结肠镜肠道准备中的应用[J].医疗装备,2016,29(5):137-138.
12 Asai S,Fujimoto N,Tanoue K,et al.Water immersion colonoscopy facilitates straight passage of the colonoscope through the sigmoid colon without loop formation:Randomized Controlled Trial[J].Dig Endosc,2015,27(3):345-353.
13 Ball AJ,Johal SS,Riley SA.Position change during colonoscope withdrawal increases polyp and adenoma detection in the right but not in the left side of the colon:results of a randomized controlled trial[J].Gastrointest Endosc,2015,82(3):488-94.
14 Parmar R,Martel M,Rostom A,et al.Validated Scales for Colon Cleansing:A Systematic Review[J].Am J Gastroenterol,2016,111(2):197-204.
15 Kluge MA,Williams JL,Wu CK,et al.Inadequate Boston Bowel Preparation Scale scores predict the risk of missed neoplasia on the next colonoscopy[J].Gastrointest Endosc,2018,87(3):744-751.
16 ASGE Standards of Practice Committee,Saltzman JR,Cash BD,et al.Bowel preparation before colonoscopy[J].Gastrointest Endosc,2015,81(4):781-794.
17 赵莉,许乐,刚锐,等.复方聚乙二醇电解质散对老年患者肠道准备效果的随机对照研究[J].中华消化内镜杂志,2015,32(3):164-166.
18 Song M,Kwek AB,Law NM,et al.Efficacy of small-volume simethicone given at least 30 min before gastroscopy[J].World J Gastrointest Pharmacol Ther,2016,7(4):572-578.
19 Kim HG,Jeon SR,Kim MY,et al.How to predict adequate bowel preparation before colonoscopy using conventional polyethylene glycol:prospective observational study based on survey[J].Dig Endosc,2015,27(1):87-94.
20 顾勇,李娜,崔海斌,等.结肠镜检查肠道准备四种方法效果比较[J].武警医学,2015,26(8):805-807.
21 Yeo SH,Kwak JH,Kim YU,et al.Comparative Study on Bowel Preparation Efficacy of Ascorbic Acid Containing Polyethylene Glycol by Adding Either Simethicone or 1 L of Water in Health Medical Examination Patients:A Prospective Randomized Controlled Study[J].Korean J Gastroenterol,2016,67(4):189-197.
22 Elvas L,Areia M,Brito D,et al.Premedication with simethicone and N-acetylcysteine in improving visibility during upper endoscopy:a double-blind randomized trial[J].Endoscopy,2017,49(2):139-145.
23 Leung WK,Lo OS,Liu KS,et al.Detection of colorectal adenoma by narrow band imaging(HQ190)vs.high-definition white light colonoscopy:a randomized controlled trial[J].Am J Gastroenterol,2014,109(6):855-63.