内镜新技术及肠道准备质量降低结直肠息肉漏诊率的研究进展

Study progress on the reduction of colorectal polyp miss rates through new endoscopic techniques and the quality of bowel preparation

摘要:

结直肠癌（CRC）是全球常见的消化道恶性肿瘤之一，其发生率和死亡率在许多地区呈现持续升高的趋势。目前，结肠镜检查和治疗是预防CRC发生和发展的关键措施。结肠镜检查和治疗可对发现的息肉等癌前病变进行切除，是预防结直肠癌发生，降低其死亡率的关键措施，但在临床应用过程中，存在遗漏部分息肉的情况。影响息肉漏诊率（PMR）的因素有很多，如：患者自身状况、操作设备、操作者经验、肠道准备情况和息肉特征等。因此，改善结直肠PMR的方法也层出不穷。内镜新技术主要包括：人工智能（AI）、远端辅助装置、图像增强内镜和新式镜头等。其中，AI和远端辅助装置的应用越来越广泛，在降低PMR方面显示出明显优势。另外，良好的肠道准备质量是降低漏诊率的关键之一。随着人们对药物质量和口味的追求，肠道清洁剂的种类越来越多。肠道准备质量不仅与肠道清洁剂有关，还受患者年龄和慢性病史等多方面的综合影响。该文将围绕内镜新技术及肠道准备质量作一综述。

Abstract:

Colorectal carcinoma (CRC) is a prevalent form of malignant neoplasm within the digestive tract on a global scale. Many regions have observed a persistent upward trend in both the incidence and mortality rates of this condition. Colonoscopy examination and treatment are key measures in preventing the occurrence and development of CRC. However in clinical practice, there are situations where some polyps are missed. It is widely recognized that the removal of precancerous lesions, such as polyps detected during a colonoscopy, is a key measure for the prevention of CRC and the reduction of its mortality rate. There are many factors which affect the polyp miss rate (PMR), such as the patient's own constitution and operating equipment and operator, and bowel preparation and polyp condition. Consequently, there has been a proliferation of methodologies designed to address colorectal PMR: new endoscopic technologies mainly include artificial intelligence (AI), distal assist devices, image-enhanced endoscopy and newer lenses, etc. Among these, AI and distal assist devices are becoming more widely used and has shown significant benefits in reducing PMR. In addition, a good quality bowel preparation is one of the foundations for reducing miss rates. With the quest for quality and taste in medicines, the variety of bowel cleansers is increasing. Bowel preparation is not only related to bowel cleansers, but is also influenced by the patient's age, chronic medical history and many other factors. This article provides a review of new endoscopic techniques and the quality of bowel preparation.