Colorectal Dis：注水结肠镜检查显著降低患者不适

　　近日，上海东方肝胆外科医院的W. U. Jun发表论文，旨在通过荟萃分析确定注水结肠镜检查的有效性。之前，已知注气结肠镜检查会导致腹部疼痛和不适。研究指出，注水结肠镜检查显著降低患者在检查时的不适和腹痛，而不影响操作时间和插管成功率。该文发表在《结直肠疾病》（Colorectal Dis）杂志上。

　　荟萃分析资料为2011年10月前的数据，包括来自美联机医学文献分析和检索系统（MEDLINE）、荷兰医学文摘数据库（EMBASE）、考克兰图书馆（Cochrane）的资料数据以及重要会议的原始论文和摘要。临床评估和数据提取通过两个独立的评价系统进行。统计分析由固定效应模型或随机效应模型进行。

　　研究纳入7项研究的872例患者。荟萃分析表明，与注气结肠镜检查相比，注水结肠镜检查组需要腹部加压或体位改变的患者较少[风险比（RR）0.73，95%置信区间 （CI） 0.59，0.91]，平均疼痛评分较低（RR －1.10，95% CI －1.26，－0.95），最大疼痛评分较低（RR －2.34，95% CI －2.92，－1.76），需要按需镇静的患者较少（RR 0.45，95% CI 0.31，0.66）。在盲肠插管率、盲肠插管时间、总时间和腺瘤检出率方面没有显著差异。

与结肠镜相关的拓展阅读：

• SJG：结肠镜检查中患者中重度焦虑与预期疼痛有关
• Lancet：推荐结直肠癌疑似患者首选CT结肠镜成像诊断方法
• ANN INTERN MED :英国结肠镜检查指南更具优势
• Ann Intern Med：是否有必要对结肠镜结果阴性的患者在10年后再次行结肠镜检查？
• USMSTF发布新的《结肠镜检查及息肉切除术后随访指南》 更多信息请点击：有关结肠镜更多资讯

Comparative effectiveness of water infusion vs air insufflation in colonoscopy: a meta-analysis
Aim 
Colonoscopy with air insufflation is known to result in abdominal pain and discomfort. We aimed to determine the effectiveness of water infusion during colonoscopy through a meta-analysis.
Method 
Original papers and abstracts published up to October 2011 were searched in MEDLINE, EMBASE, Cochrane Library Database and important meeting abstracts. Clinical appraisal and data extraction were conducted by two reviewers independently. Statistical analysis was performed by meta-analysis using a fixed effects model or a random effects model.
Results 
Seven studies involving 872 patients were included. Meta-analysis showed that the water infusion group had fewer patients requiring abdominal compression or position change [risk ratio (RR) 0.73, 95% CI 0.59, 0.91], a lower mean pain score (RR -1.10, 95% CI -1.26, -0.95), lower maximum pain score (RR -2.34, 95% CI -2.92, -1.76) and fewer patients requiring on-demand sedation (RR 0.45, 95% CI 0.31, 0.66) than the air insufflation group during colonoscopy. There were no significant differences in caecal intubation rate, caecal intubation time, total procedure time and adenoma detection rate.
Conclusion 
Water infusion significantly decreases patient discomfort and abdominal pain during colonoscopy without affecting operation time and intubation success rate.