水交换进镜方式对结肠镜检查质量影响的Meta分析

Meta-analysis of the effect of water exchange on quality of colonoscopy

摘要:

目的 比较水交换与常规注气进镜方式对结肠镜检查质量的影响。方法 计算机检索PubMed、Web of Science、the Cochrane Library、中国生物医学文献数据库、中国知网和万方数据，搜集关于水交换与单纯注气的常规进镜方式对结肠镜检查质量影响的研究，检索时限为建库至2022年10月8日。由2名研究员独立完成对文献的筛选、数据提取和质量评价。采用RevMan 5.4.1软件对纳入文献进行Meta分析。结果 共纳入23项研究，10 654例患者，Meta分析结果显示，水交换虽延长了进镜时间（MD = 1.81，95%CI：1.28～2.35，P = 0.000），但其腺瘤检出率（ADR）（OR＾ = 1.40，95%CI：1.26～1.55，P = 0.000）、盲肠插管率（OR＾ = 1.62，95%CI：1.24～2.10，P = 0.000）和肠道准备质量评分（MD = 0.61，95%CI：0.42～0.79，P = 0.000）高于常规进镜方式，疼痛评分（MD = -1.07，95%CI：-1.39～-0.76，P = 0.000）、腹部按压（OR＾ = 0.42，95%CI：0.29～0.60，P = 0.000）和体位变化（OR＾ = 0.59，95%CI：0.42～0.82，P = 0.002）低于常规进镜方式，差异均有统计学意义（P < 0.05）。结论 水交换进镜方式虽延长了进镜时间，但提高了ADR、盲肠插管率和肠道准备质量评分，减轻了疼痛，降低了腹部按压和体位改变的概率，其是进行高质量结肠镜检查的较佳选择。

Abstract:

Objective To evaluate the effect of water exchange method versus conventional methods including air insufflation and carbon dioxide insufflation method for the quality of colonoscopy.Methods We searched related randomized controlled trials published up to October 2022 from PubMed, Web of Science, the Cochrane Library, SinoMed databases, CNKI, Wanfang data. Two reviewers independently searched the literatures based on standards to extract the data and evaluate the quality. Meta-analysis was conducted by RevMan 5.4.1.Results 23 studies involving 10 654 patients were included. Although cecal intubation time was prolonged in water exchange (MD = 1.81, 95%CI: 1.28 ~ 2.35, P = 0.000), but water exchange had higher adenoma detection rate (ADR) (OR＾ = 1.40, 95%CI: 1.26 ~ 1.55, P = 0.000), cecal intubation rate (OR＾ = 1.62, 95%CI:1.24 ~ 2.10, P = 0.000) and scores of bowel preparation quality (MD = 0.61, 95%CI: 0.42~0.79, P = 0.000) compared with conventional colonoscopy. In addition, WE had significantly lower pain sores (MD = -1.07, 95%CI:-1.39 ~ -0.76, P = 0.000), number of abdominal compression (OR＾ = 0.42, 95%CI: 0.29 ~ 0.60, P = 0.000) and number of position change (OR＾ = 0.59, 95%CI: 0.42 ~ 0.82, P = 0.002) than conventional colonoscopy.Conclusion Although water exchange colonoscopy prolongs cecal intubation time, but it can significantly increase ADR, cecal intubation rate and scores of bowel preparation quality. Beyond that, water exchange reduces patient pain, the proportion of abdominal compression and position change. Water exchange is a better choice for high-quality colonoscopy.