Colonoscopy is the diagnostic modality of choice for investigation of symptoms suspected to be related to the colon and for the detection of polyps and colorectal cancer(CRC). Colonoscopy with removal of detected poly...Colonoscopy is the diagnostic modality of choice for investigation of symptoms suspected to be related to the colon and for the detection of polyps and colorectal cancer(CRC). Colonoscopy with removal of detected polyps has been shown to reduce the incidence and mortality of subsequent CRC. In many countries, population screening programs for CRC have been initiated, either by selection of patients for colonoscopy with fecal occult blood testing or by offering colonoscopy directly to average-risk individuals. Several endoscopy societies have formulated quality indicators for colonoscopy. These quality indicators are almost always incorporated as process indicators, rather than outcome measures. This review focuses on the quality indicators bowel preparation, cecal intubation rate, withdrawal time, adenoma detection rate, patient comfort, sedation and complication rate, and discusses the scientific evidence supporting them,as well as their potential shortcomings and issues that need to be addressed. For instance, there is still no clear and generally accepted definition of adequatebowel preparation, no robust scientific evidence is available supporting a cecal intubation rate ≥ 90% and the association between withdrawal time and occurrence of interval cancers has not been clarified. Adenoma detection rate is currently the only quality indicator that has been shown to be associated with interval colorectal cancer, but as an indicator it does not differentiate between subjects with one or more adenoma detected.展开更多
目的:评价可变硬度结肠镜(variable-stiffness colonoscope,VSC)在老年患者结肠镜筛查中的应用价值.方法:2012-07/2013-03在我院接受大肠癌筛查项目(60-74岁年龄组)行结肠镜检查的患者共732例,随机分为:可变硬度结肠镜(VSC组)和普通成...目的:评价可变硬度结肠镜(variable-stiffness colonoscope,VSC)在老年患者结肠镜筛查中的应用价值.方法:2012-07/2013-03在我院接受大肠癌筛查项目(60-74岁年龄组)行结肠镜检查的患者共732例,随机分为:可变硬度结肠镜(VSC组)和普通成人结肠镜(standard adult colonoscope,SAC)(SAC组),分别用OLYMPUS CF-H260和FUJINON 450WM5型结肠镜完成单人结肠镜插入.统计分析两组的达盲率、达盲时间、腹痛VAS评分、变换体位/腹部按压、追加镇静镇痛药物等指标.结果:VSC组的达盲率较高(95.9%vs 90.7%,P<0.05);同时,VSC组也较少需要在检查过程中变换体位和助手协助腹部按压(12.6%vs 33.3%,P<0.01);达盲时间VSC组和SAC组近似8.2 min±3.5 min vs 9.4 min±3.2 min,P>0.05;V S C组腹痛评分较S A C组高(57.4vs 44.1),但需要镇静镇痛几率类似(4.1%vs3.8%,P>0.05).结论:使用VSC可提高达盲率,并在插入过程中较少需要体位变换和助手协助,两组达盲时间相近,VSC腹痛等不适较SAC多见,但程度较轻,并不增加需要镇静镇痛的几率.展开更多
Colonoscopy is the gold standard test for colorectal cancer screening. The primary advantage of colonoscopy as opposed to other screening modalities is the ability to provide therapy by removal of precancerous lesions...Colonoscopy is the gold standard test for colorectal cancer screening. The primary advantage of colonoscopy as opposed to other screening modalities is the ability to provide therapy by removal of precancerous lesions at the time of detection. However, colonoscopy may miss clinically important neoplastic polyps. The value of colonoscopy in reducing incidence of colorectal cancer is dependent on many factors including, the patient, provider, and facility level. A high quality examination includes adequate bowel preparation, optimal colonoscopy technique, meticulous inspection during withdrawal, identification of subtle flat lesions, and complete polypectomy. Considerable variation among institutions and endoscopists has been reported in the literature. In attempt to diminish this disparity, various approaches have been advocated to improve the quality of colonoscopy. The overall impact of these interventions is not yet well defined. Implementing optimal education and training and subsequently analyzing the impact of these endeavors in improvement of quality will be essential to augment the utility of colonoscopy for the prevention of colorectal cancer.展开更多
文摘Colonoscopy is the diagnostic modality of choice for investigation of symptoms suspected to be related to the colon and for the detection of polyps and colorectal cancer(CRC). Colonoscopy with removal of detected polyps has been shown to reduce the incidence and mortality of subsequent CRC. In many countries, population screening programs for CRC have been initiated, either by selection of patients for colonoscopy with fecal occult blood testing or by offering colonoscopy directly to average-risk individuals. Several endoscopy societies have formulated quality indicators for colonoscopy. These quality indicators are almost always incorporated as process indicators, rather than outcome measures. This review focuses on the quality indicators bowel preparation, cecal intubation rate, withdrawal time, adenoma detection rate, patient comfort, sedation and complication rate, and discusses the scientific evidence supporting them,as well as their potential shortcomings and issues that need to be addressed. For instance, there is still no clear and generally accepted definition of adequatebowel preparation, no robust scientific evidence is available supporting a cecal intubation rate ≥ 90% and the association between withdrawal time and occurrence of interval cancers has not been clarified. Adenoma detection rate is currently the only quality indicator that has been shown to be associated with interval colorectal cancer, but as an indicator it does not differentiate between subjects with one or more adenoma detected.
文摘目的:评价可变硬度结肠镜(variable-stiffness colonoscope,VSC)在老年患者结肠镜筛查中的应用价值.方法:2012-07/2013-03在我院接受大肠癌筛查项目(60-74岁年龄组)行结肠镜检查的患者共732例,随机分为:可变硬度结肠镜(VSC组)和普通成人结肠镜(standard adult colonoscope,SAC)(SAC组),分别用OLYMPUS CF-H260和FUJINON 450WM5型结肠镜完成单人结肠镜插入.统计分析两组的达盲率、达盲时间、腹痛VAS评分、变换体位/腹部按压、追加镇静镇痛药物等指标.结果:VSC组的达盲率较高(95.9%vs 90.7%,P<0.05);同时,VSC组也较少需要在检查过程中变换体位和助手协助腹部按压(12.6%vs 33.3%,P<0.01);达盲时间VSC组和SAC组近似8.2 min±3.5 min vs 9.4 min±3.2 min,P>0.05;V S C组腹痛评分较S A C组高(57.4vs 44.1),但需要镇静镇痛几率类似(4.1%vs3.8%,P>0.05).结论:使用VSC可提高达盲率,并在插入过程中较少需要体位变换和助手协助,两组达盲时间相近,VSC腹痛等不适较SAC多见,但程度较轻,并不增加需要镇静镇痛的几率.
文摘Colonoscopy is the gold standard test for colorectal cancer screening. The primary advantage of colonoscopy as opposed to other screening modalities is the ability to provide therapy by removal of precancerous lesions at the time of detection. However, colonoscopy may miss clinically important neoplastic polyps. The value of colonoscopy in reducing incidence of colorectal cancer is dependent on many factors including, the patient, provider, and facility level. A high quality examination includes adequate bowel preparation, optimal colonoscopy technique, meticulous inspection during withdrawal, identification of subtle flat lesions, and complete polypectomy. Considerable variation among institutions and endoscopists has been reported in the literature. In attempt to diminish this disparity, various approaches have been advocated to improve the quality of colonoscopy. The overall impact of these interventions is not yet well defined. Implementing optimal education and training and subsequently analyzing the impact of these endeavors in improvement of quality will be essential to augment the utility of colonoscopy for the prevention of colorectal cancer.
