期刊
DIGESTIVE DISEASES AND SCIENCES
卷 55, 期 12, 页码 3521-3529出版社
SPRINGER
DOI: 10.1007/s10620-010-1207-4
关键词
Colonoscopy; Incomplete colonoscopy; Terminal ileum intubation; Duration of colonoscopy; Flexible sigmoidoscopy; APACHE II; Medical status; Clinical trends; Epidemiology; Clinical practice
Colonoscopy instrumentation and technique have improved from 1988 to 2008. We analyze whether these improvements have resulted in improved colonoscopy performance. This was a retrospective study of 50 consecutive inpatients in 1988 vs. 1998 vs. 2008 undergoing intended colonoscopy at a teaching hospital. Patient APACHE score, cecal and terminal ileal intubation rates, procedure time, and colonoscopic diagnoses were compared for the three different years. Changes in practice of inpatient colonoscopy in 2008 from 1988 include (1) remarkably sicker inpatients undergoing colonoscopy in 2008, as indicated by: significantly higher mean APACHE II score (11.0 +/- A 6.6 vs. 5.9 +/- A 4.1, P < 0.00001), significantly more frequent monitored bed status (58% vs. 10%, OR = 12.4; 95%-ORCI: 4.31-35.4, P < 0.00001), and significantly higher rates of several chronic diseases (e.g. CHF, 24% vs. 6%, P = 0.02); (2) significantly higher colonoscopy completion rate in 2008 (88% vs. 64%; OR = 4.13, 95%-ORCI: 1.51-11.2, P = 0.009); (3) significantly higher terminal ileum intubation rate in 2008 (44% vs. 14%, OR = 4.83, 95%-ORCI: 1.85-12.5, P = 0.002); and (4) significantly shorter mean procedure time in 2008 (26.3 +/- A 7.9 min vs. 48.0 +/- A 20.3 min, P < 0.00001). The ratio of intended colonoscopy/flexible sigmoidoscopy was significantly higher in 2008 vs. 1988 (OR = 7.50, 95%-ORCI: 2.56-21.8, P < 0.00001). Internal hemorrhoids were significantly more frequently diagnosed by colonoscopy in 2008 (44% vs. 12%, OR = 5.76, 95%-ORCI: 2.12-15.5, P = 0.001), attributed to increased rectal retroflexion. Due to improved instrumentation and technique, colonoscopy has dramatically changed from 1988 to become a clinically more valuable test in 2008 as manifested by a higher completion rate, greater clinical applicability, and shorter procedure time. Colonoscopy is supplanting flexible sigmoidoscopy.
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