水交换结肠镜检查在老年患者中的应用有效性及安全性研究

Efficacy and safety of water exchange colonoscopy in elderly patients

摘要:

目的 比较水交换（WE）结肠镜检查和CO₂常规充气结肠镜检查在老年患者中的应用有效性和安全性。方法 选取2022年1月－2024年2月于该院行结肠镜检查的老年患者（≥ 65岁）340例，采用随机数表法分为WE结肠镜检查组（WE组）和CO₂常规充气结肠镜检查组（CO₂组）。比较两组患者波士顿肠道准备评分（BBPS）、退镜时间、盲肠插管时间、盲肠插管成功率、压腹情况、复查意愿、息肉检出率（PDR）、腺瘤检出率（ADR）和安全性等方面的差异。结果 WE组盲肠插管成功率为100.0%，明显高于CO₂组的96.5%，差异有统计学意义（P = 0.013）；WE组平均盲肠插管时间为（10.50±1.79）min，长于CO₂组的（7.55±1.50）min，差异有统计学意义（P < 0.01）。两组患者退镜时间和BBPS比较，差异均无统计学意义（P > 0.05）；WE组腹部压迫率为5.9%，明显低于CO₂组的13.5%，差异有统计学意义（P = 0.017）；WE组复查意愿率为98.2%，明显高于CO₂组的93.5%，WE组PDR为80.6%，明显高于CO₂组的70.6%，WE组ADR为67.1%，明显高于CO₂组的50.6%，差异均有统计学意义（P < 0.05）。多因素Logistic回归分析显示，WE是提高ADR（OR＾ = 2.027，P < 0.01）的有效影响因素。WE组和CO₂组的总体不良事件（胃肠、心肺及其他不良事件）发生率均低于3.0%，两组间比较，差异无统计学意义（P = 1.000）。结论 WE在老年患者结肠镜检查中，具有较高的应用有效性和安全性，操作前应根据患者的共病情况、肠道准备耐受性和检查意愿等进行个体化评估，以确保检查的安全性。

Abstract:

Objective A randomized controlled trial was conducted on colonoscopy inpatient and outpatients to compare the efficacy and safety of water exchange (WE) colonoscopy and CO₂ convention insufflation colonoscopy in elderly patients.Methods 340 patients underwent fully sedated colonoscopy were randomly divided into two groups according to colonoscopy with either WE colonoscopy group (WE group) and CO₂ insufflation colonoscopy group (CO₂ group). The two groups were compared in terms of Boston bowel preparation scale (BBPS), withdrawal time, cecal intubation time, cecal intubation success rate, abdominal compression, willingness to repeat, polypdetectionrate (PDR), adenoma detection rate (ADR), and safety.Results The cecal intubation success rate was significantly higher in WE group (100.0%) compared with CO₂ group (96.5%), the difference was statistically significant (P = 0.013). The average cecal intubation time of WE group was (10.50 ± 1.79) min, which was longer than that of CO₂ group (7.55 ± 1.50) min, and the difference was statistically significant (P < 0.01). Comparison of withdrawal time and BBPS between the two groups, the differences were not statistically significant (P > 0.05). The abdominal pressure rate was lower in WE group (5.9%) compared with CO₂ group (13.5%), the difference was statistically significant (P = 0.017). The rate of willingness to re-examination in the WE group was 98.2%, which was significantly higher than the 93.5% in the CO₂ group. The PDR in WE group (80.6%) was higher than that in CO₂ group (70.6%), the ADR in WE group (67.1%) was higher than that in CO₂ group (50.6%), the differences were statistically significant (P < 0.05). Multivariate Logistic regression analysis showed that WE group was an effective factor in improving ADR (OR＾ = 2.027, P < 0.01). The overall adverse events were less than 3%, with no difference between the two groups (P = 1.000).Conclusion The use of WE colonoscopy has a better improved efficacy in elderly patients, and safety should be ensured by individualized assessment of the patient’s co-morbidities, bowel preparation tolerance, and willingness prior to the procedure.