文章：

肠道清洁对息肉与腺瘤检出率的影响：一项随机临床试验的事后分析

Impact of Bowel Cleansing on Polyp and Adenoma Detection Rate: Post-Hoc Analysis of a Randomized Clinical Trial

原文发布日期：24 April 2025

DOI: 10.3390/cancers17091421

类型: Article

开放获取: 是

英文摘要：

Objectives: To assess the impact of bowel cleansing quality on polyp detection rate (PDR) and adenoma detection rate (ADR) and explore predictors of lesion detection rate in patients undergoing colonoscopy. Methods: This is a post-hoc analysis of a multicenter randomized controlled trial (RCT) comparing 1L polyethylene glycol plus ascorbate (1L PEG+ASC) vs. 4L PEG as bowel preparation for colonoscopy. Results: PDR was significantly higher (35.6% vs. 18.5%,p= 0.013), and ADR was higher even if not significantly (25.6% vs. 16.7%,p= 0.153) in patients with Boston Bowel Preparation Scale (BBPS) ≥6 over BBPS <6. Comparing patients with BBPS = 9 over BBPS = 7–8, no significant differences were found in PDR (34.5% vs. 38.4%,p= 0.483) nor ADR (24.1% vs. 27.2%,p= 0.553). At multivariable regression analysis, older age (OR = 1.042, 95%CI = 1.021–1.063;p< 0.001), shorter intubation time (OR = 0.891, 95%CI = 0.816–0.972;p= 0.010), higher withdrawal time (OR = 1.171, 95%CI = 1.094–1.253;p< 0.001) and full consumption of the first dose (OR = 8.368, 95%CI = 1.025–68.331;p= 0.047) were independently associated with ADR. Conclusions: This post-hoc analysis of a RCT showed that excellent cleansing (BBPS = 9) over high-quality cleansing (BBPS = 7–8) does not significantly improve PDR or ADR. Neither cleansing success nor preparation types were independently associated with ADR. Compliance with bowel preparation, timing of colonoscopy and withdrawal time are key elements for adequate ADR with potential implications for reducing interval colorectal cancer.

摘要翻译： 

目的：评估肠道清洁质量对结肠镜检查患者息肉检出率（PDR）和腺瘤检出率（ADR）的影响，并探讨病变检出率的预测因素。方法：本研究为一项多中心随机对照试验（RCT）的事后分析，该试验比较了1升聚乙二醇加抗坏血酸（1L PEG+ASC）与4升聚乙二醇（4L PEG）作为结肠镜检查前肠道准备方案的效果。结果：波士顿肠道准备量表（BBPS）评分≥6的患者与BBPS<6的患者相比，PDR显著更高（35.6% vs. 18.5%，p=0.013），ADR也更高，尽管差异未达统计学显著性（25.6% vs. 16.7%，p=0.153）。比较BBPS=9与BBPS=7–8的患者，PDR（34.5% vs. 38.4%，p=0.483）和ADR（24.1% vs. 27.2%，p=0.553）均无显著差异。多变量回归分析显示，年龄较大（OR=1.042，95%CI=1.021–1.063；p<0.001）、插管时间较短（OR=0.891，95%CI=0.816–0.972；p=0.010）、退镜时间较长（OR=1.171，95%CI=1.094–1.253；p<0.001）以及首次剂量完全服用（OR=8.368，95%CI=1.025–68.331；p=0.047）与ADR独立相关。结论：这项RCT的事后分析表明，与高质量清洁（BBPS=7–8）相比，极佳清洁（BBPS=9）并未显著提高PDR或ADR。清洁成功与否及准备方案类型均与ADR无独立关联。肠道准备依从性、结肠镜检查时机和退镜时间是确保足够ADR的关键因素，对降低间期结直肠癌风险具有潜在意义。

原文链接：

Impact of Bowel Cleansing on Polyp and Adenoma Detection Rate: Post-Hoc Analysis of a Randomized Clinical Trial