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中华结直肠疾病电子杂志 ›› 2019, Vol. 08 ›› Issue (05) : 486 -490. doi: 10.3877/cma.j.issn.2095-3224.2019.05.009

所属专题: 文献

论著

肠镜用水温度对注水法肠镜影响的临床分析
张慧超1, 杨幼林1,(), 牛思佳1, 尚国印1, 陈颖颖1   
  1. 1. 150001 哈尔滨医科大学附属第一医院消化内科
  • 收稿日期:2019-04-19 出版日期:2019-10-25
  • 通信作者: 杨幼林
  • 基金资助:
    黑龙江省高等教育学会高等教育科学研究"十三五"规划课题项目(No.16Q057)

Effect of water temperature on water infusion colonoscopy

Huichao Zhang1, Youlin Yang1,(), Sijia Niu1, Guoyin Shang1, Yingying Chen1   

  1. 1. Department of Gastroenterology, The 1st Affiliated Hospital of HMU, Harbin Medical University, Harbin 150001, China
  • Received:2019-04-19 Published:2019-10-25
  • Corresponding author: Youlin Yang
  • About author:
    Corresponding author: Yang Youlin, Email:
引用本文:

张慧超, 杨幼林, 牛思佳, 尚国印, 陈颖颖. 肠镜用水温度对注水法肠镜影响的临床分析[J/OL]. 中华结直肠疾病电子杂志, 2019, 08(05): 486-490.

Huichao Zhang, Youlin Yang, Sijia Niu, Guoyin Shang, Yingying Chen. Effect of water temperature on water infusion colonoscopy[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2019, 08(05): 486-490.

目的

探讨不同温度的肠镜检查用水对注水法肠镜的影响。

方法

随机对照单盲研究,纳入2017年8月至2018年2月因体检行肠镜检查患者300例,随机分为三组:注气组100人;注室温水组(22 ℃)100人;注加热水组(38 ℃)100人。由三名内镜医生随机进行单人肠镜操作,记录腹痛评分、达回盲部时间、检查成功率、息肉的检出率、体位变化、腹部按压、肠镜检查满意度、退镜时间、诊断结果等数据。

结果

注气组、注室温水组、注加热水组的三组患者的腹痛评分(5.5±4.0;3.0±2.0;3.0±1.0)、达回盲部时间(187.00±131.25 s;268.00±89.50 s;250±103.50 s)、退镜时间(137.5±62.00 s;156.50±76.25 s;156.00±67.00 s)、肠镜检查满意度(74%;87%;90%)有统计学差异(P<0.05);三组患者的检查成功率(94%;98%;97%)、息肉检出率(19.15%;24.49%;23.71%)、腹部按压及体位变化等均无统计学差异(P>0.05);其中,腹痛评分注气组明显高于注水组(P<0.05),室温水组与加热水组间无差异(P>0.05);肠镜检查满意度注水组明显高于注气组(P<0.05),室温水组与加热水组间无差异(P>0.05);达回盲部时间与退镜时间注水组明显长于注气组(P<0.05),室温水组与加热水组间无差异(P>0.05)。

结论

在非麻醉的肠镜检查中,注水法能够减少患者的腹痛,提高患者满意度,但与注气法相比会延长操作时间。水温的升高对患者的腹痛评分、到达回盲部时间、退镜时间、肠镜检查满意度、检查成功率、息肉的检出率、体位变化及腹部按压等无影响。因此室温水也可用于注水肠镜检查中。

Objective

To investigate the effect of different temperature water on water infusion colonoscopy.

Methods

This is a randomized, controlled trial that is carried out from August 2017 to February 2018 at a single center and a total of 300 subjects who underwent colonoscopy examination for cancer screening were included in this study. The patients were randomized to three groups: air insufflation group, cool water group (22℃), warm water group (38℃). The colonoscopy procedures were performed by three experienced endoscopist without any sedation. The following parameters were assessed: patients′ abdominal pain scores evaluated by the visual analogue scales (VAS), the cecal intubation time, the cecal intubation rate, the polyp detection rate, position exchange, abdominal compression, the degree of satisfaction, withdrawal time, diagnosis results.

Results

There was significance difference in the abdominal pain (5.5±4.0; 3.0±2.0; 3.0±1.0), the cecal intubation time (187.00±131.25s; 268.00±89.50 s; 250±103.50s), withdrawal time (137.5±62.00 s; 156.50±76.25s; 156.00±67.00s) and the degree of satisfaction (74%; 87%; 90%) between the three groups (P<0.05). Other outcomes were no different including the cecal intubation rate (94%; 98%; 97%), the polyp detection rate (19.15%; 24.49%; 23.71%), abdominal compression, position exchange (P>0.05). The abdominal pain scores in the air insufflation group is much higher than two water infusion groups (P<0.05), but there is no difference between the two water infusion groups (P>0.05); the degree of satisfaction in the air insufflation group is much lower than two water infusion groups (P<0.05), but there is no difference between the two water infusion groups (P>0.05); the cecal intubation time and withdrawal time in the two water infusion groups are longer than air insufflation group (P<0.05), there is no difference between the two water infusion groups (P>0.05).

Conclusion

Although water method needs more time to reach the cecum, it can reduce abdominal pain and improve degree of satisfaction compared with the air method. There is no difference between the warm water group and the cool water group in abdominal pain scores, the cecal intubation time, withdrawal time, degree of satisfaction, the cecal intubation rate, the polyp detection rate, abdominal compression, position exchange. Therefore, water do not need to be warmed in water infusion colonoscopy.

图1 三组患者腹痛评分的直方图
表1 基本信息三组比较结果
表2 主要指标及次要指标三组比较结果
表3 腹痛评分及达回盲部时间三组组间比较结果分析
[1]
Sugimoto S, Mizukami T. Diagnostic and therapeutic applications of water-immersion colonoscopy [J]. World J Gastroenterol, 2015, 21(21):6451-6459.
[2]
Baumann UA. Water intubation of the sigmoid colon: water instillation speeds up left-sided colonoscopy [J]. Endoscopy, 1999, 31(4): 314-317.
[3]
Ransibrahmanakul K, Leung JW, Mann SK, et al. Comparative effectiveness of water vs. air methods in minimal sedation colonoscopy performed by supervised trainees in the US randomized controlled trial [J]. Am J Clin Med, 2010, 7(3): 113-118.
[4]
Leung FW, Harker JO, Jackson G, et al. A proof-of-principle, prospective, randomized, controlled trial demonstrating improved outcomes in scheduled unsedated colonoscopy by the water method [J]. Gastrointest Endosc, 2010, 72(4): 693-700.
[5]
Lin S, Zhu W, Xiao K, et al. Water intubation method can reduce patients′ pain and sedation rate in colonoscopy: a meta-analysis [J]. Dig Endosc, 2013, 25(3): 231-240.
[6]
Church JM. Warm water irrigation for dealing with spasm during colonoscopy: simple, inexpensive, and effective [J]. Gastrointest Endosc, 2002, 56(5): 672-674.
[7]
Yang C, Sriranjan V, Abou-Setta AM, et al. Anxiety associated with colonoscopy and flexible sigmoidoscopy: a systematic review [J]. Am J Gastroenterol, 2018, 113(12): 1810-1818.
[8]
Lee BY, Katon R, Herzig D, et al. Warm water infusion during sedated colonoscopy does not decrease amount of sedation medication used [J]. Gastrointest Endosc, 2012, 76(6): 1182-1187.
[9]
Falt P, Šmajstrla V, Fojtík P, et al. Cool water vs warm water immersion for minimal sedation colonoscopy: a double-blind randomized trial [J]. Colorectal Dis, 2013, 15(10): e612-e617.
[10]
Lohsiriwat V. Colonoscopic perforation: incidence, risk factors, management and outcome [J]. World J Gastroenterol, 2010, 16(4): 425-430.
[11]
Ko CW, Dominitz JA. Complications of colonoscopy: magnitude and management [J]. Gastrointest Endosc Clin N Am, 2010, 20(4): 659-671.
[12]
Kim WH, Cho YJ, Park JY, et al. Factors affecting insertion time and patient discomfort during colonoscopy [J]. Gastrointest Endosc, 2000, 52(5): 600-605.
[13]
Hafner S, Zolk K, Radaelli F, et al. Water infusion versus air insufflation for colonoscopy [J]. Cochrane Database Syst Rev, 2015 (5): CD009863.
[14]
Hu D, Xu Y, Sun Y, et al. Water infusion versus air insufflation for colonoscopy: a meta-analysis of randomized controlled trials [J]. Tech Coloproctol, 2013, 17(5): 487-496.
[15]
Jin P, Liu Y, Huang Q, et al. Water exchange versus air insufflation for colonoscopy: A meta-analysis [J]. Saudi J Gastroenterol, 2018, 24(6): 311-316.
[16]
Seop LJ, Soo KE, Kyu JM, et al. An unexpected adverse event during colonoscopy screening: bochdalek hernia [J]. Korean J Gastroenterol, 2018, 71(5): 290-293.
[17]
Harewood GC, Sharma VK, de Garmo P. Impact of colonoscopy preparation quality on detection of suspected colonic neoplasia [J]. Gastrointest Endosc, 2003, 58(1): 76-79.
[18]
Froehlich F, Wietlisbach V, Gonvers JJ, et al. Impact of colonic cleansing on quality and diagnostic yield of colonoscopy: The European Panel of Appropriateness of Gastrointestinal Endoscopy European multicenter study [J]. Gastrointest Endosc, 2005, 61(3): 378-384.
[19]
Rex, Douglas K. Polyp detection at colonoscopy: Endoscopist and technical factors [J]. Best Pract Res Clin Gastroenterol, 2017, 31(4): 425-433.
[20]
李芳伟, 张军, 左爱丽, 等. 退镜时间对大肠息肉检出率影响的研究[J]. 中华消化内镜杂志, 2009, 26(4): 207-208.
[21]
Facciorusso A, Triantafyllou K, Murad MH, et al. Compared abilities of endoscopic techniques to increase colon adenoma detection rates: A network meta-analysis [J]. Clin Gastroenterol Hepatol, 2018 Dec 6.
[22]
Lesne A, Rouquette O, Touzet S, et al. Adenoma detection with blue-water infusion colonoscopy: a randomized trial [J]. Endoscopy, 2017, 49(8): 765-775.
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