Z Gastroenterol 2020; 58(10): 955-959
DOI: 10.1055/a-1213-6701
Originalarbeit

Routine ileal intubation in colonoscopy does not increase the polyp detection rate: a retrospective study

Keine Erhöhung der Polypenerkennungsrate durch routinemäßige Intubation des Ileums bei Koloskopie: eine retrospektive Studie
Weiyi Wang
1   Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China., Shanghai, China
2   Department of Gastroenterology, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China., Shanghai, China
3   Department of Endoscopy, Shanghai Tong Ren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
,
Ke Chen
4   Department of Endoscopy, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, PR China, Shanghai, China
,
Ying Xu
1   Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China., Shanghai, China
2   Department of Gastroenterology, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China., Shanghai, China
,
Yufen Zhou
1   Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China., Shanghai, China
2   Department of Gastroenterology, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China., Shanghai, China
,
Ping Chen
1   Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China., Shanghai, China
2   Department of Gastroenterology, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China., Shanghai, China
› Author Affiliations

Abstract

Colonoscopy is effective in the prevention and screening of colorectal cancer. Whether terminal ileal (TI) intubation is required during conventional colonoscopy and whether it offers clinical benefits with respect to polyp detection rate (PDR) remain unclear. This retrospective study included patients who underwent colonoscopy at our hospital between July 1, 2018 and April 20, 2019. The positive findings and time for TI intubation were recorded. Univariate and multivariate analyses were performed to identify factors associated with PDR. There were 1675 patients with cecal intubation colonoscopy, including 994 (59 %) with TI intubation and 8 (1 %) with intestinal disease. The mean time for TI intubation was 40 seconds (3–338), and the mean time from cecal intubation to arrival at the deep part of TI mucosa was 24 seconds (2–118). The overall PDR was 27 %. On multivariable analysis, age > 50 years [95 % confidence interval (CI) 2.837–4.590], male sex (95 %CI, 0.406–0.649), presence of symptoms (abdominal symptoms vs. asymptomatic, 95 % CI, 1.146–2.468; stool changes vs. asymptomatic, 95 % CI, 1.070–1.834), and non-TI intubation (95 % CI, 1.040–1.648) were independent predictors of higher PDR. Trend analysis indicated decreasing trend of PDR among non-TI intubation group, 0–5 cm TI intubation group, and > 5 cm TI intubation group (30 % vs. 27 % vs. 24 %, respectively; p < 0.05). TI intubation is necessary to identify small bowel disease among a designated population, but it was not suggested to be routinely performed as part of colonoscopy, owing to limited positive intestinal findings, extra time requirement, and possible PDR worsening.

Zusammenfassung

Die Koloskopie ist eine effektive Untersuchungsmöglichkeit bei der Prävention und Früherkennung eines Kolorektalkarzinoms. Nicht bestätigt ist, ob bei der konventionellen Koloskopie eine Intubation des terminalen Ileums erforderlich ist und inwieweit diese klinisch vorteilhaft in Bezug auf die Polypenerkennungsrate ist. Diese retrospektive Studie schloss Patienten ein, die sich zwischen dem 1. Juli 2018 und dem 20. April 2019 in unserer Klinik einer Koloskopie unterzogen haben. Die positiven Befunde und die Zeit für die Intubation des terminalen Ileums wurden aufgezeichnet. Es wurden univariate und multivariate Analysen durchgeführt, um Faktoren im Zusammenhang mit der Polypenerkennungsrate zu identifizieren. Bei 1675 Patienten wurde eine Zökalkoloskopie durchgeführt, davon bei 994 (59 %) eine Intubation des terminalen Ileums; 8 der Patienten (1 %) litten unter einer Darmerkrankung. Die mittlere Zeit für die Intubation des terminalen Ileums betrug 40 s (3–338) und die mittlere Zeit von der Zökumintubation bis zum Erreichen des tiefen Bereichs der Ileum-Schleimhaut betrug 24 s (2–118). Die Gesamt- Polypenerkennungsrate betrug 27 %. Bei der multivariablen Analyse waren Alter > 50 Jahre [95 % Konfidenzintervall (KI) 2,837–4,590], männliches Geschlecht (95 % KI, 0,406–0,649), Vorliegen von Symptomen (abdominales Symptom vs. asymptomatisch, 95 % KI, 1,146–2,468; Stuhlveränderungen vs. asymptomatisch, 95 % KI, 1,070–1,834) und keine Intubation des terminalen Ileums (95 % KI, 1,040–1,648) unabhängige Prädiktoren für eine höhere Polypenerkennungsrate. Die Trendanalyse zeigte einen abnehmenden Trend der Polypenerkennungsrate in der Gruppe ohne Intubation des terminalen Ileums, der Gruppe mit 0–5 cm Intubation des terminalen Ileums und der Gruppe mit > 5 cm Intubation des terminalen Ileums (30 % vs. 27 % vs. 24 %; P < 0,05).

Eine Intubation des terminalen Ileums ist notwendig, um eine Dünndarmerkrankung bei einer bestimmten Patientengruppe zu erkennen; es wird jedoch nicht empfohlen, diese routinemäßig im Rahmen einer Koloskopie durchzuführen, da nur eine begrenzte Anzahl an positiven Befunden ermittelt wurde, mehr Zeit benötigt wird und sich die Polypenerkennungsrate möglicherweise verschlechtert.



Publication History

Received: 23 March 2020

Accepted: 06 July 2020

Article published online:
09 October 2020

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