2024中國(guó)腸道準(zhǔn)備指南解讀及研究進(jìn)展

中國(guó)腸道準(zhǔn)備指南解讀及研究進(jìn)展10081.67055.547.941.630肺癌

結(jié)腸癌

胃癌

乳，腺癌

肝癌中國(guó)癌譜變化按癌定發(fā)病數(shù)計(jì)算，排名前五的癌癥依次為肺癌、結(jié)直腸癌、感、乳家癌、肝癌，肺癌仍然是我國(guó)最高

發(fā)的癌癥，據(jù)估計(jì)，2020年中國(guó)新增肺癌病例81萬(wàn)。結(jié)直腸癌發(fā)病數(shù)超起過(guò)胃癌位居第二；乳腺癌取代

肝癌成為第四順位常見癌。我國(guó)CRC

發(fā)病情況Changing

profilesofcancerburdenworldwideand

inChina:

asecondaryanalysisoftheglobalcancerstatistics2020發(fā)病率/10萬(wàn)人4190如何發(fā)現(xiàn)早期結(jié)腸癌?適齡、無(wú)癥狀、平均風(fēng)險(xiǎn)人群篩查首次檢查時(shí)遺漏

(52%)完整切除后新發(fā)

(24%)病灶切除不完整

(19%)活檢失敗誤診斷

(5%)25.4deaths

pExpected

from

general

population(SEER9)12

deathsObservedadenomacohortObservedNPSnonadenomacohort0.0中024

6

8

10

12

14161820結(jié)腸鏡對(duì)結(jié)腸癌的預(yù)防價(jià)值結(jié)腸鏡檢查后發(fā)生結(jié)腸癌的原因結(jié)腸鏡可使結(jié)腸癌死亡率下降≥50%Gut.2014;63(6):949-56.N

Engl

J

Med.2012;366(8):687-96.1.6-1.4-

1.2-1.0-

0.8-0.6-0.4-

0.2-CumulatveColorectalCancerMortalityYears

FollowedNPSSERRATEDLESIONSho

DAPPCGastroenterologyProtumorigenicImmuneNetworksinHCC18901617

Mucoalmpdncan

aphagpalone1717

UseofFibraScan

in

Patiens

Wt

NAFLD1761poleofTGFandjNKSgnlng

in

EsophpealCrdnopeness1849HoatmmuneBauonbyHCCBoleofpDuIF=20.7結(jié)腸胰腺癌漏診率有多高?ZhaoSB,BaiY,LiZS.Gastroenterology.2019;156:1661-1674.ADR

APPC

APIC結(jié)腸腺癌漏診原因患者因素腸道準(zhǔn)備

看得清醫(yī)生因素操作技術(shù)

看得全腸道準(zhǔn)備質(zhì)量與結(jié)腸病變發(fā)現(xiàn)率理想的腸道準(zhǔn)備理想腸道準(zhǔn)備柏愚，李兆申.中國(guó)早期結(jié)直腸癌篩查及內(nèi)鏡診治指南.中華消化內(nèi)鏡雜志.2015;32(6):1-20.現(xiàn)實(shí)腸道準(zhǔn)備Impactof

coloniccleansingonqualityanddiagnosticyield

ofcolonoscopy:the

European

Panel

of

Appropriateness

ofGastrointestinalEndoscopyEuropeanmulticenterstudyFlorianFrochlich,MD,VincentWietlisbach,BAt,JeanJacquesGonvers,MD,BernardBurnand,MD,MPH,John-PaulVader,MD,MPHLausanne

and

Basle,Switzerland

11個(gè)歐美國(guó)家21家內(nèi)鏡中心，5,832例結(jié)腸鏡進(jìn)境時(shí)間腸道準(zhǔn)備不理想的影響中華內(nèi)科雜志2019年7月第58卷第7期Chin

J

Intern

Med,July2019,Vol.58,No.7中國(guó)消化內(nèi)鏡診療相關(guān)腸道準(zhǔn)備指南(2019,上海)1腸道準(zhǔn)備的目的和要求5

祛炮劑2患者告知及患教6

口服腸道清潔劑禁忌癥3飲食限制7特殊患者的腸道準(zhǔn)備4腸道清潔劑選擇和用法8

小腸鏡和膠囊內(nèi)鏡指南主要內(nèi)容腸道準(zhǔn)備目的和要求Adler

etat,201312.0%1.56(3)Aslanianetal,20131.1%1.39

(0.33,5.86)Chilu

etal,201112.5%1.16(0.86,1.57)deJongoet

at,201210.4%2.13(1.49,3.03)Froehlichetat,200513.3%1.46(1.11,1.93)Jover

etal,201373%1.35

(0.84,2.16)Porez

etal,201172%1.45(0.90,2.34)Aadaelliet

at

200819.6%1.10(0.96,1.26)Sherer

etat,201216.6%1.52(1.24,1.86)Total

(95%CI)-0.-18.11.100.0%-.1.41[1.21,1.64]推薦1:內(nèi)鏡醫(yī)師應(yīng)在結(jié)腸鏡操作過(guò)程時(shí)評(píng)估患者腸道準(zhǔn)備情況，醫(yī)療機(jī)構(gòu)應(yīng)定期監(jiān)測(cè)腸道準(zhǔn)備合格率Meta:

高質(zhì)量腸道準(zhǔn)備的ADR

比低質(zhì)量腸道準(zhǔn)備高41%StudyorSubgroupWeightOddsRato,95%COddsRatio,95%CI證據(jù)質(zhì)量：低；推薦強(qiáng)度：強(qiáng)02

0.5Favors

FayorgLow-quality

High-qualityAmJGastroenterol.2014;109(11):1714-23Haterogeneity:203:2df

8(P=0

02);2=56%Testfor

overall

effect

Z=435(P<0.0001)0.1Comprehensive

validation

ofthe

Boston

Bowel

Preparation

ScaleAudrey

H.Calderwood,MD,Brian

C.Jacobson,MD,MPH,FASGEBoston,Massachusetts,USAGastrointest

Endosc2010;72:686-92.腸道準(zhǔn)備目的和要求ORIGINAL

ARTICLE:Clinical

Endoscopy推薦2:采用波士頓量表或渥太華評(píng)估腸道準(zhǔn)備情況證據(jù)質(zhì)量：高；推薦強(qiáng)度：強(qiáng)波士頓量表評(píng)分標(biāo)準(zhǔn)0由于無(wú)法清除的固體或液體糞便導(dǎo)致整段黏膜無(wú)法觀察(A)1由于污斑、混濁液體、殘留糞便導(dǎo)致部分黏膜無(wú)法觀察(B)2腸道黏膜觀察良好，但殘留少量污斑、混濁液體、糞便(C)3腸道黏膜觀察良好，基本無(wú)殘留污斑、混濁液體、糞便(D)肝曲、橫結(jié)腸、脾曲總分降結(jié)腸、乙狀結(jié)腸、直腸波士頓腸道評(píng)分量表盲腸、升結(jié)腸推薦3:腸道準(zhǔn)備前應(yīng)向患者提供口頭聯(lián)合書面的詳細(xì)指導(dǎo)，并強(qiáng)調(diào)依從的重要性，有條件的單位可聯(lián)合電話，短

信和微信等輔助方式指導(dǎo)患者進(jìn)行腸道準(zhǔn)備患者告知及宣教Telephone-basedre-educationon

the

daybeforecolonoscopy

improves

the

qualityof

bowel

preparationandthe

polypdetection

rate:a

prospective,colonoscopist-blinded,randomised,controlledstudyXiaodong

Liu,'Hui

Luo,'Lin

Zhang,'Felix

WLeung,?3Zhiguo

Liu,'Xiangping

Wang,'Rui

Huang.'Na

Hu,'Kaichun

Wu,Daiming

Fan,Yanglin

Pan,'Xuegang

Guo1EffectofWeChatandshortmessageserviceonbowelpreparation:anendoscopist-blinded,randomizedcontrolled

trialShuUng

Wang'.Oan

Wang',Jun

Yao,Sheng-BngZhao",USheng

Wang.Zhao

ShenU

and

YuBat證據(jù)質(zhì)量：高；推薦強(qiáng)度：強(qiáng)

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Jia,ZhiguoLu,ZhangqinChen,

JunjunLiu,'KaichunWu,DaimingFan,YanglinPan,andXuegangGuo*sysnMATICRviWANDMETA-ANAIMsisDeliveryofInstructionsvia

MobileSocial

Media

AppIncreasesQualityof

Bowel

Preparation⑩◆腸道準(zhǔn)備的意義，重要性◆瀉藥使用的時(shí)間，劑量及方法◆飲食限制的時(shí)間和要求◆其他措施的應(yīng)用◆強(qiáng)調(diào)依從性的重要性◆出現(xiàn)不良反應(yīng)的應(yīng)對(duì)措施<結(jié)腸鏡檢查準(zhǔn)備須知取消關(guān)注填寫預(yù)約信息

歷史消息

常見問(wèn)題患者告知及宣教術(shù)前宣教內(nèi)容危險(xiǎn)因素(N=409)OR95%CIP

value便秘2.051.31-3.230.002未

全

量

服

用

P

E

G2.771.47-5.210.002腸鏡前24h高纖維飲食2.151.40-3.28<0.001OriginalarticleConstipation,fiberintake

andnon-compliancecontributetoinadequatecolonoscopybowelpreparation:aprospectivecohort

study腸道準(zhǔn)備不佳的比例：36.4%長(zhǎng)海醫(yī)院消化內(nèi)鏡中心患者腸道準(zhǔn)備不佳的原因FangJ,BaiY,LiZS.JDigDis.2016;17;458-46310090798070608

5040313017.5207.51010腸道準(zhǔn)備腸道準(zhǔn)備是腸鏡受檢者最大的負(fù)擔(dān)其他

沒(méi)有

未說(shuō)明NicholsonFB,ctal.JMod

Scroon.2005:12:89-95乙狀結(jié)腸鏡

結(jié)腸鏡7.5

24

2恢復(fù)操作過(guò)程焦慮尷尬25255551最痛苦的就是喝電解質(zhì)的過(guò)程

剛喝完瀉藥，真的無(wú)比難喝，喝到后來(lái)直接吐于是接著一直喝到見底，快吐了

其實(shí)做腸鏡還好，就是灌腸藥比較難喝。最煩人的就是瀉藥了，真的很惡心，聚乙二醇喝吐了，明早還要喝三大杯清腸的藥喝不下去怎么辦，吐了兩次了太難喝了，特別是磷酸鈉鹽聞著像雪碧，可是太咸了，我差點(diǎn)吐了這個(gè)味道，喝一口一路苦澀到胃子里，惡心的要死瀉藥味道太詭異，喝水太撐提高患者對(duì)腸道準(zhǔn)備的依從性●

腸道準(zhǔn)備時(shí)惡心嘔吐，腹脹等不良反應(yīng)波動(dòng)20-25%左右●

癥狀嚴(yán)重者影響腸道準(zhǔn)備效果，降低今后復(fù)查結(jié)腸鏡的意愿喝瀉藥難受還是排泄難受?答案是：喝瀉藥難受，滿滿三升啊!整個(gè)腸鏡過(guò)程中，最難過(guò)的就是喝瀉藥服用瀉藥

腸鏡檢查中的疼痛腸道清潔劑分類指南推薦內(nèi)容聚乙二醇(PEG)電解質(zhì)散3L

PEG的分次劑量方案可提供高質(zhì)量的腸道清潔；鎂鹽硫酸鎂可作為常用腸道清潔劑，腎功能異常、炎癥性腸病者避免使用磷酸鈉不常規(guī)使用口服磷酸鈉進(jìn)行腸道準(zhǔn)備，口服磷酸鈉前應(yīng)先評(píng)估腎功能匹可硫酸鈉復(fù)方匹可硫酸鈉可用于內(nèi)鏡檢查前的腸道準(zhǔn)備，耐受性較好甘露醇不建議治療性結(jié)腸鏡使用甘露醇進(jìn)行腸道準(zhǔn)備番瀉葉原葉、蓖麻油中草藥制劑應(yīng)與其他腸道清潔劑聯(lián)合使用以減少不良反應(yīng)腸道清潔劑的分類根據(jù)《中國(guó)消化內(nèi)鏡診療相關(guān)腸道準(zhǔn)備指南(2019,上海)》,腸道清潔劑主要分為以下幾種：EffectofWeChatandshortmessageservice

on

bowel

preparation:

anendoscopist-blinded,randomizedcontrolledtrialShuLngWang',QianWang",JunYao*,Sheng-BngZhao°,UShengWang,Zhao-ShenLandYuBar●

國(guó)內(nèi)，單中心，前瞻性，隨機(jī)對(duì)照研究●

436例結(jié)腸鏡前接受腸道準(zhǔn)備患者●

常規(guī)+微信vs.常規(guī)+短信vs.常規(guī)微信組患者腸道準(zhǔn)備質(zhì)量?jī)?yōu)于短信組

微信組和短信組均優(yōu)于常規(guī)組患者告知及宣教WangSL,

BaiY,LiZS,etal.EurJGastroenterolHepatol.2019,31(2).170-177.飲食限制MedicineSvsnMATicRevEWANDMHIA-AsALysisPENRegimefor

Bowel

Preparation

in

Patients

ScheduledtoColonoscopy:Low-Residue

Diet

or

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Liquid

Diet?

Evidence

FromSystematic

ReviewWith

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Tian.AIN.

UMa.MN,LUJwnM.MN.TingShnat.AIN.云

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Xian-Tao

Zeng

MD推薦4:術(shù)前采用低渣/低纖維飲食，飲食限制一般不超過(guò)24h證據(jù)質(zhì)量：高；推薦強(qiáng)度：強(qiáng)證據(jù)質(zhì)量：高；推薦強(qiáng)度：強(qiáng)Low-residueversusclearliquiddietbeforecolonoscopy:m,omily

T

Nanon

mo

sab

pan

Mp.Inine.(ahbonuhocu.mwkOlumbus.Moocsunt.tsA推薦5:亦可采用術(shù)前1天清洗流質(zhì)飲食SYSTEMATCREVIEWANDMETA-ANALYSISimpact

of

dietliberalization

on

bowel

preparationcolonoscopyameta-analysisof

randomized,controlledtrialsg0TheforOttawabowel飲食限制●

中國(guó)臺(tái)灣地區(qū)，單中心，前瞻性，觀察性研究●804例腸道準(zhǔn)備患者。書面指導(dǎo)飲食并記錄●

評(píng)估實(shí)際飲食含渣量對(duì)腸道準(zhǔn)備效果的影響●

只有44.2%患者最終嚴(yán)格遵守飲食指導(dǎo)建議Impact

of

Low-Residue

Diet

on

Bowel

PreparationforColonoscopy含渣量越高腸道準(zhǔn)備合格率越低Dietary

residue

content

Dietary

residue

content

score加強(qiáng)飲食管理，提高腸道準(zhǔn)備依從性中華消化內(nèi)鏡雜態(tài)2019年12月第36卷第12期

ChinJDgFnkac,Decmber2019,Val,36,Noa12低渣全營(yíng)養(yǎng)配方粉在結(jié)腸鏡腸道準(zhǔn)備中的應(yīng)用價(jià)值初探潘鳴趙勝兵2王潤(rùn)東'王樹玲'孫洪在'夏天'常欣'顧倫'李兆中

柏愚'SAT腸道準(zhǔn)備質(zhì)量

患者耐受性SATWED3標(biāo)準(zhǔn)化無(wú)渣代餐WED3患者自備

低渣飲食THU4腸鏡THU4腸鏡MON2MON2SUN1SUN1潘鵬，趙勝兵，柏愚.中華消化內(nèi)鏡雜志，2019,36(12):923-927.5FRI5TUETUE腸鏡受檢者

隨機(jī)66FRI觀察指標(biāo)試驗(yàn)組(n=32)對(duì)照組(n=29)P年齡(歲)51±1350±120.886男性(%)17(53%)12(41%)0.359診斷性結(jié)腸鏡(%)27(84%)23(79%)0.607飲食限制依從率(%)25(78%)16(55%)0.057腸道準(zhǔn)備完成率(%)30(94%)27(93%)0.919進(jìn)鏡時(shí)間(分)9.1±2.99.8±3.70.417腸道準(zhǔn)備評(píng)分7.8±1.07.1±1.30.037腸道準(zhǔn)備合格率(%)87.5%79.3%0.388腸鏡前饑餓感(%)11(34%)14(48%)0.102不良反應(yīng)發(fā)生率(%)1(3%)1(3%)0.944加強(qiáng)飲食管理，提高腸道準(zhǔn)備依從性潘鵬，趙勝兵，柏愚.中華消化內(nèi)鏡雜志，2019,36(12):923-927.飲食限制

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中的應(yīng)用價(jià)值初探潘鴟'趙勝兵王潤(rùn)東王樹玲孫洪鑫'夏天常欣顧倫李兆申

拍感推薦6:采用標(biāo)準(zhǔn)化的預(yù)包裝低渣/低纖維飲食有助提高依從性O(shè)RIGNALCONTRBUTIOWControlledDietaryRestrictionWith

aPrepackagedLow-Residue

Diet

BeforeColonoscopyOffersBetter-Quality

BowelCleansingandAllowsthe

Use

ofaSmallerVolumeofPurgatives:A

Randomized

MulticenterTrial證據(jù)質(zhì)量：高；推薦強(qiáng)度：弱常用腸道清潔劑的選擇和用法理想的腸道清潔劑標(biāo)準(zhǔn)能短時(shí)間內(nèi)排空糞便

>

不引起結(jié)腸粘膜改變

>

不引起患者明顯不適

>

不導(dǎo)致水電解質(zhì)紊亂

>

價(jià)格適中，依從性好磷酸鈉制劑聚乙二醇制劑匹可硫酸鈉中草藥鎂鹽制劑甘露醇聚乙二醇制劑安全性好，適用人群廣泛，孕婦及嬰幼兒的首選用藥>

電解質(zhì)紊亂，晚期肝癌，心衰和腎衰竭患者均可服用最常見不良反應(yīng)：腹脹，惡心，嘔吐；發(fā)生率~2.5%常用腸道清潔劑的選擇和用法：聚乙二醇PEGOR(95%C0Aoe0.3/20.030,3000

0.909450,206)41450604910120.201185-21cas0ender13160524,3.306)FmukSmokin901,108)Dm07400326,1.67)

0470Como06740247,180)H

13440482,374)H

冊(cè)1700490,6534hevous

atdomndo

pehe

s1221241.3480303.6002)H

17130703,4176)0.938(0.465,1.891)0.85812常用腸道清潔劑的選擇和用法：聚乙二醇PEG◆國(guó)內(nèi)，單中心，前瞻性隨機(jī)對(duì)照研究◆330例腸道準(zhǔn)備患者；3Lvs4L

PEGOPEN3-LSplit-dose

isSuperior

to

2-L

Polyethylene

Glycol

in

Bowel

Cleansingin

ChinesePopulationAMulticenterRandomized,ControlledTrialShenghong

Zhang.MD,PhD,Minruf

Li,AMD,Yagang

Zhao,MD,PhD,Tao

Lv,MD,PhD.Qing

Shn,MD,PhD.FachaoZh,MD.PhD,YCun,MD.amdMinhm

Chen,MD.PhD

3L

PEG分次方案不弱于4LPEG方案

hed6d

coonosco(500

yean22523-2521-24LPEG

group1001134352PEGgroupSubgroup100/103123127130136110115405093963202515287938588M常用腸道清潔劑的選擇和用法：聚乙二醇PEG3LPEG分次服用方案：結(jié)腸鏡檢查前1天晚上8點(diǎn)服用1L

PEG

結(jié)腸鏡當(dāng)天檢查前4~6h服用2L

PEG推薦7:3L聚乙二醇的分次劑量方案可提供高質(zhì)量的腸道情節(jié)效果，適合中國(guó)人群證據(jù)質(zhì)量：高；推薦強(qiáng)度：強(qiáng)文中高危風(fēng)險(xiǎn)因素：年齡>70歲，便秘，糖尿病，帕金森病，中風(fēng)或脊柱病史脊髓損傷，既往血壓不足史，BMI>25,

以及使用三環(huán)類抗抑郁藥或麻醉劑常用腸道清潔劑的選擇和用法：聚乙二醇PEG推薦8:在腸道準(zhǔn)備不充分低風(fēng)險(xiǎn)人群中也可采用2LPEG的單次劑量方案Same-Day

Single

Doseof2

Liter

Polyethylene

Glycol

is

Not

Inferior

to

The

Standard

Bowel

PreparationRegimen

in

Low-Risk

Patients:A

Randomized,

Controlled

TrialXayuKang

MD9,ing

Ztao,MO,Zhong

Zhu,MD,Fe

Laung

WD?,Ume

Wang

MD,XangingWng

MD.

Hulun,MD

Lhu

Zhng

MOITac

Dong

MO,Pnongu.MD.Zhangon(Chn,MO.Gu

Ran,MO,Hua.MO.Xaag6in.MOYagnPan.MC,)eanGn,MOandlanmFan,MO證據(jù)質(zhì)量：高；推薦強(qiáng)度：強(qiáng)ORIGNALCONTRBUTIONS口硫酸鎂物美價(jià)廉，國(guó)內(nèi)很多單位將其作為腸道準(zhǔn)備的重要選擇口有引起粘膜炎癥，潰瘍風(fēng)險(xiǎn)及造成粘膜形態(tài)改變的可能，因此不

推薦確診及可以的IBD

患者服用，慢性患者也不宜使用口

用

法：內(nèi)鏡檢查前4~6h,

硫酸鎂50g加清水100ml

稀釋后一次

性服用，同時(shí)飲水約2L,

建議大便呈清水樣便時(shí)，不再飲水常用腸道清潔劑的選擇和用法：鎂鹽推薦9:硫酸鎂可作為腸道準(zhǔn)備的常用清潔劑但腎功能異常和IBD

患者應(yīng)避免使用證據(jù)質(zhì)量：低；推薦強(qiáng)度：弱常用腸道清潔劑的選擇和用法：磷酸鈉WARNINGSThere

havebeanare,butseriousreportsof

acutephospbatenephropathvinpatientswhoreceivedoralsodumphosphateproductsforcoloncleansingpriortocolonoscopy.Somecaseshaveresultedimpermanentimpaimentof

renalfunctionandsomepatientsrequiredlong-term

dialysis

While

some

cases

have

occrred

in

patientswithout

identifable

riskfactors,patientsatincreasedriskof

acutephosphatenephropathymayinclndethosewithincreased

agehypovolemiaincreasedboweltransittime(sich

asbowel

obstnuction)activecolitis,orbaselinekidneydisease,andthoseusingmedicinesthataffectrenalperfiusionorfinction(suchasdiuretics.angiotensinconvertingenzyme

[ACE]inhibitors.angiotensinreceptorblockers

[ARBs].andpossiblynonsteroidalanti-inflammatorydugs

[NSAIDs]SeeWARNINGSItisimportanttousethedoseand

dosing

regimenasrecommended(pm/am

splitdose).

See

DOSAGE

and

ADMLNISTRATION推薦10:不常規(guī)使用口服磷酸鈉進(jìn)行腸道準(zhǔn)備僅用于有特定需求無(wú)法被其他制劑代替，口服前應(yīng)先評(píng)估腎功能年齡小于18歲或大于65歲；活動(dòng)性炎癥性腸??；腸道梗阻慢性腎病、低血容量、電解質(zhì)紊亂、肝硬化

充血性心竭、心律失常、長(zhǎng)期高血壓病史服用ACEI、ARB、利尿劑、NSAIDs

者證據(jù)質(zhì)量：高；推薦強(qiáng)度：強(qiáng)Visicol

Tablets(sodiumphosphatemonobasicmonohydrate,USP,and

sodumphosphatedibasic

anhydrous,USP)□以下患者慎用磷酸鈉：FDA黑框警告口刺激性瀉劑，其活性代謝物質(zhì)直接作用于結(jié)腸粘膜，增加液體分泌，可刺激結(jié)腸蠕動(dòng)口目前匹可硫酸鈉在國(guó)內(nèi)尚未上市，相關(guān)隨機(jī)對(duì)照研

究較少，國(guó)外的高質(zhì)量研究不多常用腸道清潔劑的選擇和用法：匹可硫酸鈉mbecmamsP9

d2Pto?amdaro30on

ve

pm

Atod

5s

tono+m

ahe

A推薦11:復(fù)方匹可硫酸鈉可用于內(nèi)鏡檢查前的腸道準(zhǔn)備，耐受性較好證據(jù)質(zhì)量：中等；推薦強(qiáng)度：弱PE0s

C

aotSplit-dose

bowel

cleansing

with

picosulphate

is

safesolutionBsatsthMH.Matuowwg

Kam

wanarWet

ngeWonuwd-vandeSiom

amd

som

s.Saowkand

bettertoleratedthan2-1polyethyleneglycolEur

J

GastroenterolHepatol.2018;30(7):709-717.o聲

dPoo4苦t

oon

comn13

s9ma言cound1eg常用腸道清潔劑的選擇和用法：甘露醇口不良反應(yīng)口高滲，易致液體丟失，水電解質(zhì)紊亂；有利尿和升血糖作用，糖尿病患者禁用口結(jié)腸內(nèi)被細(xì)菌酵解后產(chǎn)生爆炸性氣體(甲烷和氧氣),因此禁用于高頻電治療CASE

REPORTS

FatalColonicExplosionDuringColonoscopicPolypectomyMARC-ANDREBIGARD,PIERREGAUCHER,andCLAU

e

Mal

dAie

dSeAF

ared

Digeatit-Centre

HospitalierUnivetsitairede

Nancy.Nanra

20

colonic

gas

explosion4polypectomyperforations1

deathA

patient

is

described

who

sustoined

the

first

re.

ported

colonic

explosion

during

colonoscopic

pol

ypectomy.Mannitol

solutionwas

usedforhowel

preporotion,andthecolonwascompletelyclean.duringcholetystectomyforsallstones.TheACMIFOR

1-metercnlonoscopewasusedtortheexaminationTheco

lon

proved

to

be

poorly

prepared.The

hepaticfexurepolyp

was

rumoved

by

snare

polypctomy

without

inGastroenterology.1979;77:1307證據(jù)質(zhì)量：低；推薦強(qiáng)度：強(qiáng)推薦12:不建議在治療結(jié)腸鏡中使用甘露醇進(jìn)行腸道清潔Figure1

Flowchartof

published

caseswih

colonic

gas

explosionWorldJ

Gastroenterol.2007;13.5295-8.perforations2

perforatisur

rgeryAPC44番瀉葉口某些醫(yī)院仍在使用，但不建議單多作腸道準(zhǔn)備用

口不良反應(yīng)：腹痛腹脹較常見，可致粘膜炎癥改變口用法：檢查前晚番瀉葉20g加400ml

(原葉20倍質(zhì)

量)開水浸泡30min

或80℃水溫浸泡1h服用常用腸道清潔劑的選擇和用法：中草藥推薦13:中草藥制劑應(yīng)與其他腸道清潔劑聯(lián)合使用以減少不良反應(yīng)證據(jù)質(zhì)量：低；推薦強(qiáng)度：弱結(jié)腸鏡檢查前的輔助措施：祛泡劑口結(jié)腸鏡檢查時(shí)，腸道泡沫的發(fā)生率約30-40%

口大量泡沫會(huì)影響對(duì)結(jié)腸粘膜及病灶的觀察口國(guó)內(nèi)六中心，隨機(jī)，對(duì)照研究□

600例結(jié)腸鏡前腸道準(zhǔn)備患者□

2LPEG+西甲硅油vs.2LPEG祛泡劑組腸道準(zhǔn)備更佳，腺癌檢出率更高結(jié)腸鏡檢查前的輔助措施：祛泡劑Impact

of

preproceduresimethicone

on

adenoma

detectionrate

during

colonoscopy:a

multicenter,endoscopist-blinded

randomized

controlled

trialOriglnal

articlePEG+

西甲硅油

PEG腸道準(zhǔn)備質(zhì)量腸道息肉檢出率祛泡劑dok:10.11METAANALYSISAND

SYSTEMATICREVIEWEffect

of

supplemental

simethicone

for

bowel

preparation

onadenoma

detection

during

colonoscopy:A

meta-analysis

ofrandomized

controlled

trialsPengPan·ShengBingZhao'BngHanuOan-OanMeng.'JunYao'Dong

Wanghao

Shenu*and

Yu

faSimethicone

Use

During

Gastrointestinal

Endoscopy:Position

Statement

of

theGastroenterologicalSocietyofAustraliaBenedictMDevereauxMB.BS2.AndrewCFTaylorMD2,EugeneAthanMD',DavidJWallis

BN2,Robyn

R

Brown

RN',Sue

M

Greig

MN?,Fiona

K

Bailey

MPH2,Karen

Vickery

PhD,EliabethWardleRN?,DianneMJonesBAppse口用法推薦：西甲硅油30ml,可與最后一次瀉藥同時(shí)服用，或者在瀉藥服用后30~60min

內(nèi)服用推薦14:在腸道準(zhǔn)備過(guò)程中建議常規(guī)應(yīng)用祛泡劑Impact

of

preprocedure

simethicone

on

adenoma

detection

rate

during

colonoscopy:a

multicenter,endoscopist-blinded

randomized

controlled

trialAuh

hatenF,ajtWinwh,

gzh

.Dpng

Wang'Ye

Qingw.

ho

sh,0-0ineo-0nno證據(jù)質(zhì)量：高；推薦強(qiáng)度：強(qiáng)Gatroenterolorr

ind

Hepato·慢性便秘，未嚴(yán)格按照要求進(jìn)行腸道準(zhǔn)備(術(shù)前高纖維飲食，PEG

引用不足),肥胖，高齡，既往結(jié)腸外科手術(shù)史，伴有其他疾病(如糖尿病，帕金森等),服用抗抑郁藥等腸道準(zhǔn)備不佳高?；颊逥ipostive

DiseishurnutetDgeureDoaw20te

17:4463

dot

101111/1751-2980.12376OriginalarticleConstipation,fiber

intakeand

non-compliancecontributetoinadequatecolonoscopybowelpreparation:a

prospectivecohort

study危險(xiǎn)因素

i

t

i

i

a

hMQe-l

lonoscopy

@KunjatGandh.ChristinaTofani,"CarlySokach,'DovinPatet'DavidKastenberg.andConstantineDaskalakisnalysisy

ofCoaitaatuticReview

andAssociatedWitmcsstestSyer:Aacnrparatioent

ChaPrePatPredictorsofSuboptimalBowelPreparationUsing3-1

fP

loys

t

c

eO

ioornanl

S

u

atient

Colonoscopy:KRiskfactorsforinadequatebowelpreparation:

avalidatedpredictivescorehunTANG,*longVu.yunAIoROISAL

AWmc,6CinlcatGastoentarlouandhopatology2010,16.397-309WANGChn

Sog4nm

og腸道準(zhǔn)備不佳高危風(fēng)險(xiǎn)患者推薦15:對(duì)于純?cè)谀c道準(zhǔn)備不充分危險(xiǎn)因素的患者可在應(yīng)用標(biāo)準(zhǔn)腸道準(zhǔn)備方案的同時(shí)采取額外準(zhǔn)備措施0ptimizing

Adequacy

of

Bowel

Cleansing

for

Colonoscopy:

Recommendations

From

the

US

Multi-Society

Task

Force

on

Colorectal

CancerDavidA.Johnson,'AlanN.Barkun,LaryB.Cohen,JasonA.Dominitz,'TonyaKaltenbach,

Myriam

Martel,Douglas

J.Robertson.C.Richard

Boland,"Frances

M.Giardello,DavidA.Leberman,Theodore

R

Levin,"andDouglas

K.Rex"可選輔助措施：4L

PEG方案，術(shù)前3天低渣飲食，使用促胃腸動(dòng)力藥物等證據(jù)質(zhì)量：高；推薦強(qiáng)度：強(qiáng)Comparison

ofTwo

Intensive

Bowel

Cleansing

Regimens

in

PatientsWith

Previous

Poor

BowelPreparation:ARandomizedControlledStudyORIGINALCONTRIBUTIONSAGA

SECTIONGastoentemlogy2014147903-924腸道準(zhǔn)備不充分患者推薦16:若內(nèi)鏡檢查過(guò)程中發(fā)現(xiàn)患者腸道準(zhǔn)備不充分。應(yīng)積極評(píng)估，并采取補(bǔ)救措施或改期行內(nèi)鏡檢查A

Randomized

ControlledTrial

Comparing

ColonoscopicEnema

With

AdditionalOralPreparationasaSalvageforInadequate

BowelCleansingBeforeColonoscopySoo-Kr

-

kn

h

S

mmg

e

MD+YamhoJngMD

PhDfChang

Soo

Emm

MD

PhDfandDong

Soo

Han

MD.PhDSc*LDachoMDTkAI/ng*DuP*DDMMDYamPaJoungHro證據(jù)質(zhì)量：高；推薦強(qiáng)度：強(qiáng)Colonoscopic

enema

as

rescue

for

inadequate

bowelpreparationbeforecolonoscopy:a

prospective,observational

studyA.Horluchi,Y.Nalayama't,M.Kajyama*,N.Kato*,T.Kamljima*,Y.Ichhe?andN.Tanaka4補(bǔ)救措施：2L

PEG口服Hassteun2012cgst27Mea2Aundat

oa0orjpulartded×101m/1+63-0201203107ORIGINAL

ARTICLE患有或疑似炎癥性腸病者JoumalafCohe

s

ndCoits2014,1-10doi101030/ecco

jc[s040

Advince

Acess

pabicatoo

Febrary13.201906ginalArnceOriginalArticleEfficacy,Tolerability,andSafety

ofLow-Volume

Bowel

Preparations

forPatients

with

Inflammatory

Bowel

Diseases:

The

French

Multicentre

CLEAN

Study推薦17:對(duì)患有或疑似IBD患者，避免使用磷酸鹽類清潔劑盡量使用小劑量聚乙二醇方案World

JournalofGastroenterologysopt

hop//wwwpaboshingzom

WuCwn07ApBu9%40nDoE

10745/mgev2354

S6N10079027punn

ISSN2219240

onlane證據(jù)質(zhì)量：中等；推薦強(qiáng)度：弱WLU1oUWICSystematic

reviewandmeta-analysisofcoloncleansing

preparations

in

patientswith

inflammatory

boweldisease小劑量方案：2LPEG下消化道出血患者Cinical

Gastoenterology

and

kepatobogy2016,14558-564Safetyand

EffectivenessofEarlyColonoscopy

in

Manag