肠道准备充分患者退镜时间对腺瘤检出率的影响

Impact of withdrawal time on adenoma detection rate in patients with adequate bowel preparation

摘要:

目的 探讨肠道准备充分患者退镜时间对腺瘤检出率（adenoma detection rate，ADR）的影响。方法 前瞻性纳入18~85岁入院接受结肠镜筛查、随访与诊断的患者，采用3 L聚乙二醇电解质溶液分次剂量肠道准备，主要观察指标为ADR，次要观察指标为波士顿肠道准备量表（Boston bowel prepration scale，BBPS）评分、退镜时间、盲肠插镜时间与息肉检出率。结果 2022年5月至2023年5月间共1 495例肠道准备充分的患者纳入分析，年龄（51.8±11.9）岁。随BBPS评分从6至9分升高，ADR逐渐降低［6分46.1%（41/89）、7分42.1%（88/209）、8分39.3%（166/422）、9分34.3%（266/775），χ2=8.621，P=0.035］，中位退镜时间逐步缩短（6分7.1 min、7分7.0 min、8分6.7 min、9分6.6 min，H=27.580，P<0.001）。BBPS为6、7分的肠道准备良好组与BBPS为8、9分的肠道准备优秀组比较，组间ADR［43.3%（129/298）比36.1%（432/1197），χ2=5.274，P=0.022］与中位退镜时间（7.0 min比6.6 min，t=4.851，P<0.001）差异有统计学意义。多因素逻辑回归分析显示，性别、年龄、退镜时间与盲肠插镜时间是ADR的独立影响因素，而BBPS评分在多因素分析中差异无统计学意义（P=0.585）。结论 在肠道准备充分的患者当中，退镜时间比优秀的肠道准备更为重要，无论BBPS评分如何，确保足够的退镜时间进行充分地观察，有利于更好地完成高质量结肠镜检查。

Abstract:

Objective To explore the impact of withdrawal time (WT) on adenoma detection rate (ADR) in colonoscopies with adequate bowel preparation. Methods Patients aged 18‑85 years who underwent colonoscopy for screening, surveillance, or diagnosis were prospectively included. All patients received split‑dose bowel preparation with 3 L of polyethylene glycol electrolyte solution. The primary outcome was ADR; and the secondary outcomes were Boston bowel prepration scale (BBPS) score, WT, cecal intubation time, and polyp detection rate. Results A total of 1 495 patients with adequate bowel preparation from May 2022 to May 2023 were included (mean age 51.8±11.9 years). Increased BBPS scores (6 to 9 points) correlated with progressively lower ADR [6 points 46.1%（41/89）, 7 points 42.1%（88/209）, 8 points 39.3%（166/422）, 9 points 34.3%（266/775）, χ2=8.621, P=0.035] and shorter withdrawal times (6 points 7.1 min, 7 points 7.0 min, 8 points 6.7 min, 9 points 6.6 min, H=27.580, P<0.001). There were significant differences in ADR [43.3%（129/298） VS 36.1%（432/1197）, χ2=5.274, P=0.022] and WT (7.0 min VS 6.6 min, t=4.851, P<0.001) between good (BBPS 6‑7 points) versus excellent preparation groups (BBPS 8‑ 9 points). Multivariate logistic regression analysis showed that gender, age, WT, and cecal intubation time were independent influencing factors for ADR, while BBPS score was not statistically significant (P=0.585). Conclusion Among patients with adequate bowel preparation, withdrawal time demonstrates greater influence than bowel preparation quality on adenoma detection. Regardless of the BBPS score, maintaining sufficient withdrawal duration remains crucial for optimal colonoscopy quality.