Evaluating a combined bowel preparation for small-bowel capsule endoscopy:a prospective randomized–controlled study  

一种联合肠道准备方案用于胶囊内镜检查:前瞻性随机对照研究

作　　者：Stephanie L.Hansel Joseph A.Murray Jeffrey A.Alexander David H.Bruining Mark V.Larson Thomas F.Mangan Ross A.Dierkhising Ann E.Almazar Elizabeth Rajan 

机构地区：[1]Division of Gastroenterology and Hepatology,Mayo Clinic,Rochester,MN,USA [2]Division of Biomedical Statistics and Informatics,Mayo Clinic,Rochester,MN,USA

出　　处：《Gastroenterology Report》2020年第1期31-35,I0001,I0002,共7页胃肠病学报道（英文）

基　　金：Salix Pharmaceuticals,Raleigh,NC,USA.

摘　　要：Background:Capsule endoscopy(CE)is frequently hindered by intra-luminal debris.Our aim was to determine whether a combination bowel preparation would improve small-bowel visualization,diagnostic yield,and the completion rate of CE.Methods:Single-blind,prospective randomized–controlled study of outpatients scheduled for CE.Bowel-preparation subjects ingested 2 L of polyethylene glycol solution the night prior to CE,5mL simethicone and 5mg metoclopramide 20 minutes prior to CE and laid in the right lateral position 30 minutes after swallowing CE.Controls had no solid food after 7 p.m.the night prior to CE and no liquids 4 hours prior to CE.Participants completed a satisfaction survey.Capsule readers completed a small-bowel-visualization assessment.Results:Fifty patients were prospectively enrolled(56%female)with a median age of 54.4 years and 44 completed the study(23 patients in the control group and 21 in the preparation group).There was no significant difference between groups on quartile-based small-bowel visualization(all P>0.05).There was no significant difference between groups in diagnostic yield(P=0.69),mean gastric(P=0.10)or small-bowel transit time(P=0.89).The small-bowel completion rate was significantly higher in the preparation group(100%vs 78%;P=0.02).Bowel-preparation subjects reported significantly more discomfort than controls(62%vs 17%;P=0.01).Conclusions:Combined bowel preparation did not improve small-bowel visualization but did significantly increase patient discomfort.The CE completion rate improved in the preparation group but the diagnostic yield was unaffected.Based on our findings,a bowel preparation prior to CE does not appear to improve CE performance and results in decreased patient satisfaction(ClinicalTrials.gov,No.NCT01243736).背景:胶囊内镜检查效果常受制于肠道内的食物残渣。本研究旨在评价一种联合肠道准备方安能否改善小肠视野,从而提高疾病诊断率和检查完成率。方法:本研究为前瞻性单盲随机对照研究,研究对象为在预约进行胶囊内镜检查的Mayo Clinic门诊患者。肠道准备组患者在胶囊内镜检查前夜饮用2 L聚乙二醇溶液,检查前20 min服用5mL西甲硅油和5mg胃复安,吞入胶囊内镜30 min后采用右侧卧位。对照组不做肠道准备,仅于检查前晚7点后禁食固体食物,检查前4 h内禁水。对所有研究对象进行满意度调查。胶囊内镜读片人员进行小肠视野评估。结果:前瞻性纳入50例患者,其中女性占56%,中位年龄54.4岁。44例完成研究,其中肠道准备组21例,对照组23例。两组患者在小肠四个分区中的视野清晰度的差异均无统计学意义(均P>0.05)。两组患者的疾病诊断率(P=0.69)、胃传输时间(P=0.10)和小肠传输时间(P=0.89)也均相当。肠道准备组的检查完成率显著高于对照组(100%vs 78%,P=0.02),但患者不适感也显著增多(62%vs 17%,P=0.01)。结论:联合肠道准备应用于胶囊内镜检查并没有改善小肠视野,却给患者带来了更多不适。尽管能提高检查完成率,但联合肠道准备并没有提高疾病检出率。因此,肠道准备似乎并不能改善胶囊内镜检查效果,反而会影响患者满意度。

关 键 词：bowel preparation capsule endoscopy small-bowel visualization patient satisfaction 

分 类 号：R574[医药卫生—消化系统]