The Relationship Between Anti-loop Technique Of Abdominal Pressure And Colonoscopic Cecal Intubation Process And The Quality Of Colonoscopy:Prospective Randomized Controlled Clinical Trials

Section1 Reasons for colonoscopic cecal intubation failure in an average risk population of colorectal cancer and loops of the colonoscopyObjective:Success of cecal intubation is the foundation of a complete colonoscopy.The cecal intubation is to control the quality of colonoscopy from the perspective of a full colonoscopy.There are many factors that can affect the rate of cecal intubation,but the domestic report did not elaborate on this issue,especially lacking prospective clinical research evidence.Our aim is to find the risk factors and reasons for cecal intubation failure in the Chinese population.Methods:This is a single center,prospective observational study.From October 2014 to January 2015,an observational study was conducted on patients undergoing colonoscopy in the Gastrointestinal Endoscopy Center of Changhai Hospital,Second Military Medical University,who was included in this study.The success of the cecal intubation was recorded.Age,sex,weight,height of constipation,history of abdominal surgery,history of diabetes,hypertension,history of colonoscopy,causes of go hospital(diarrhea,abdominal pain,blood in the stool,changes in bowel habits,changes in stool properties,etc.)Bowel preparation quality,usage of anti-loop technique of abdominal pressure and other related information is recorded.Bowel preparation grading criteria were measured using the Aronchick score.Results:A total of 1320 subjects were selected and completed the study.The possible risk factors for cecal intubation failure were gender(P = 0.002),abdominal surgery(P = 0.005),hypertension(P = 0.038),age(P<0.001),bowel prepared quality(P = 0.185).Multivariate analysis found that eld(OR,0.936;95% CI,0.915-0.958)and poor quality of bowel preparation(OR,1.542;95% CI,1.164-2.403)were independent risk factors for cecal intubation failure.(P <0.001).The anti-loop technique of abdominal pressure can improve CIR(P<0.001).Conclusions:There are many factors that affect the success of the cecum intubation,we found that: poor preparation quality of bowel and eld may be the main reasons for the failure of cecum intubation.The anti-loop technique of abdominal pressure can improve the CIR.These findings can help us to better improve the CIR,improve the quality of colonoscopy.Section2 The relationship between anti-loop technique of abdominal pressure and colonoscopic cecal intubation process and the quality of colonoscopy:Prospective Randomized Controlled Clinical Trials Objective : The anti-loop technique of abdominal pressure is widely used in colonoscopy.The clinical experience suggests that this technique is indispensable in the course of colonoscopy,especially in the process of difficulty colonoscopy.However,there are still controversial aspects of the objective effectiveness and effectiveness of anti-loop technique of abdominal pressure in the process of colonoscopy and the quality control of examination.The purpose of this study is to explore whether the anti-loop technique of abdominal pressure can optimize the process of cecal intubation and the quality control indicators.Methods:This is a single center,prospective,randomized controlled clinical trial.From December 2015 to December 2016,patients who underwent colonoscopy in the Gastrointestinal Endoscopy Center of Changhai Hospital Affiliated to Second Military Medical University of China were included.The patients were randomly assigned to the anti-loop technique of abdominal pressure group or control group.Both groups were treated with modified double colonoscopy.Anti-loop technique of abdominal pressure group were treated in accordance with conventional methods and taken abdominal pressure to prevent the initial loop or re-knot loop by the GI assist if necessary,which was decided by operator;The control group were treated in accordance with conventional methods in the absence of abdominal pressure.Age,sex,weight,height of constipation,history of abdominal surgery,history of diabetes,hypertension,history of colonoscopy,causes of go hoapital(diarrhea,abdominal pain,blood in the stool,changes in bowel habits,changes in stool properties,etc.)Bowel preparation quality and other related information is recorded.To observe and compare the two groups of mean insertion time,cecal intubation rate,body length of the colonoscopy at insertion point,polyp detection rate,the patient pain score,the frequence of anti-loop technique of abdominal pressure usage,the efficient of anti-loop technique of abdominal pressure usage,Events and so on.Bowel preparation quality grading criteria were measured using the Aronchick score.Results:A total of 450 subjects were included in the study,of which 449 completedthe study(225 cases of the control group,224 cases of the anti-loop technique of abdominal pressure group for the test group).There was no significant difference in demographic data between the two groups.There was no statistically significant difference in bowel preparation scores between the two groups(P = 0.613).The cecal intubation rate in the test group was significantly higher than immediate cecal intubation rate in the control group(96.9% vs 80.4%,P <0.001),but there was no significant difference between the cecal intubation rate in the test group and the final cecal intubation rate in the control group(96.9% vs 96.4%,P =0.800).The intubation length of the colonoscope body was shorter than that of the control group(77.93 ± 12.99)cm vs(86.84 ± 17.32)cm,P <0.001.The pain score of the patients in the test group was lower than that of the control group 3(2,5)vs 5(4,7),P <0.001.The detection rate of polyps in the test group was higher than that in the control group,no significant difference(31.3% vs 27.6%,P=0.390).The detection rate of adenoma in the test group was higher than that in the control group,but the difference was not statistically significant(26.3% vs25.3%,P=0.808).The number of polyps detected per colonoscopy of the patient with polyp in the test group was higher than that in the control group,the difference was statistically significant[1(1,2)vs 1(1,2),P=0.040)],The number of polyps detected per colonoscopy of the patient with polyp during withdraw time in the test group was higher than that in the control group,the difference was statistically significant[1(1,1)vs 1(0,1),P=0.012)],There was no significant difference in the number of polyps detected per colonoscopy of the patient with polyp during insertion time[0(0,1)vs 1(0,1),P=0.658)].The number of polyps detected in all the subjects in the test group during withdraw time was higher than that in the control group,the difference was statistically significant[0(0,0)vs 0(0,0),P=0.041)].The number and composition ratio of polyps(27)3mm detected during withdraw time in the test group were significantly higher than those in the control group(P=0.042).The prospective data summary in our center show that the conventional usage rate of the anti-loop technique of abdominal pressure was 85.3%,the average number per colonoscopy were 1.44 times,overall success rate of anti-loop technique of abdominal pressure was 75.5%.Conclusions:This study found that anti-loop technique of abdominal pressure can improve the cecum intubation,reduce the risk of intubation with loops,shorten the intubation time into the cecum,improve patient satisfaction with colonoscopy,there is the possibility of detection of more small polyps to reduce the polyps missed rate.These findings can theoretically help us to better improve cecal insertion rate and improve thequality of colonoscopy.Section3 Clinic application of anti-loop technique of abdominal pressure in the treatment of obstructive colorectal cancer with self-expanding metallic stentsObjective : The anti-loop technique of abdominal pressure is widely used in colonoscopy.The application of the technique can reduce the cecum intubation with loops.This study aims to compare the short-term clinical outcomes and the long-term oncologic outcomes of self-expanding metallic stents(self-expanding metallic stents,SEMS)as a bridge to surgery(SEMS group)with those of emergency surgery(ES group)for malignant colorectal obstruction(malignant colorectal obstruction,MCO)premise of this technique,under a modified two-person colonoscopy method.Methods:Adopting the method of retrospective study.The clinical data of 60 patients with MCO who accepted operation treatment at the Second Military Medical University Chang-hai Hospital between October 2007 and December 2012 were collected.Twenty-seven patients who underwent semi-elective curative resection after endoscopic SEMS insertion premise of the anti-loop technique of abdominal pressure,under a modified two-person colonoscopy method,without x-ray perspective,were included in the SEMS group,thirty-three patients who underwent emergency curative surgery were included in ES group.The clinic pathologic characteristics and overall survival(overall survival,OS)were compared between the two groups.The multidisciplinary discussion and evaluation was given to all of all of these patients preoperative.Results:There were no significant differences in general information,tumor stage,location,and histology between the SEMS group and the ES group.The usage rate of the anti-loop technique of abdominal pressure in SEMS group of 100%(27/27).The success rate of stent implantation in SEMS group was 100%(27/27),and the clinical success rate was 96.3%(26/27).The incidence of perioperative complications of SEMS group and ES group were was 7.4%(2 cases)and 21.2%(7 cases).The median OS times were 37 months for the SEMS group and 23 months for the ES group.The proportions of patients who received postoperative adjuvant chemotherapy were comparable(SEMS group vs.ES group,70.4% vs.45.5%;P=0.138).The long-term oncologic outcome did not significantly different between two groups in the 3-year OS rate(55.6% vs.39.4%;P=0.2119)and the 5-year OS rate(48.1%vs.36.4%;P=0.3570).Conclusions:In our center,the reasonable usage of the anti-loop technique of abdominal pressure in a modified two-person colonoscopy method in the treatment of obstructive colorectal cancer with non-fluoroscopic metal stent placement is safe,effective and feasible in terms of short-term clinical outcomes and long-term oncology outcomes.