| BackgroundThe gastrointestinal cancer is one of the main health issues around the world. Although the incidence of gastric cancer has been decreased along with the Helicobacter pylori eracdication in recent years, the incidence of esophageal cancer and colorectal cancer hasn’t been alleviated. Gastrointestinal cancer may be an important problem that we have to faced for quite a long time. Some pathogenesis factors of gastric cancer and colorectal cancer have been clarified, nearly 90% of gastric cancer caused by Helicobacter pylori infection, and almost all of the non-hereditary colorectal cancer developed from adenoma. These clues provide us some relatively clear pathways to prevent gastrointestinal cancer. Endoscopy can directly observe the intestinal tract, identify the lesions, and cure the lesions. This is one of the advantages of the gastrointestinal cancer treatment compare with the same malignant neoplasm in other part of the body. With the promotion and advancement of endoscopy technology, the popularity of endoscopic screening and the upper gastrointestinal tract and colorectal lesions detection rates have been increased in recent years. Endoscopic mucosal resection and endoscopic submucosal desection technology have been extensively developed. Therefore, it is possible to cure early digestive tract cancer. Thus, survival rate of patients should be greatly improved.But endoscopy is far from perfect. Several factors may influence the detection effect, such as the debris of food,the secretion of mucus, bubbles and foams, refluxed pancreatic juice and bile gathered in gastrointestinal tract. These substances influence the observation of the gastrointestinal mucosa, rinse the mucous membrane would prolong the checking time, added the sedation and analgesia drug dosage during painless endoscopy, put extra burden on the patients. At the same time, due to the gastrointestinal tract complexity itself, the endoscopic operation is largely affected by endoscopic physicians experience, moreover the colonoscopy is far more complex compared with gastroendoscopy, and the difficulty of the operation is also greatly increased. For many patients, when face to the check-pain, fear, and anxiety,they sometimes evade accepting the colonoscopy for disease screening.How to increase the mucosal visibility under the endoscopy, and improve the patients compliance, enhance the lesion detection rate, endoscopists and investigators have been striving to solve these problems for a long time. They have tried many methods, such as administer kinds of anti-foam agents and protein enzyme drugs to remove bubbles, foams gathered in the intestinal tract before endoscopy. Several gaseous and liquid agents have been used for colon cavity expansion, to enhance the cecal intubation rate and lesion detection rate, such as carbon dioxide, water, or oil insufflation, cap-assisted colonoscopy. Several technologies have been developed to detect the lesions like high-definition amplification endoscope, chromoendoscope, confocal laser endomicroscope.To start from the situation of our country, various advanced endoscopic equipment s and the drug used before endoscopic examination have not been spreaded yet. Considering the cost of the patients, if we can use the simplest method to solve the problems of the poor visibility of the mucosa under endoscopy, poor compliance of the patients and low lesion detection rate, we would obtain the biggest benefit.Therefore, considering of these aspects, our research aiming to adopt a new simple method to solve these clinical problems. Our research is safe, not to affect inspection time and no additional costs, but high cost of performance can be achieved. We hope it can be accepted and promoted by endoscopists and patients.ObjectivesTo investigate whether a 360-degree horizontal turn after oral premedication with simethicone improves the mucosal visibility and the precancerous lesions detection rate during gastroendoscopic examination; and to observe the cap-assisted colonoscopy cominbined with carbon dioxide insufflation whether or not affect the colonscopy insertion rate and adenoma detection rate.Methods1.The influence of the administered simethicone combined with body turn over to the lesion detection and the mucosa visibility under gastroendoscopy.From July 2013 to August 2013, a total of 1182 outpatients enrolled in the study, at last involved 993 patients scheduled for gastroendoscopy. And the patients general conditions were recorded: age, gender, chief complaint, contact information and so on. Just before gastroendoscopy, after oral premedication with simethicone, patients were random Ly assigned to three groups:in group A, patients waited for 20 min before gastroendoscopy; in group B, patients were separately waited for 5/10/15/20 min and were then turned 360 degrees just before gastroendoscopy; in group C, patients were immediately turned 360 degrees and then separately waited for 5/10/15/20 min before examination. According to the waiting time, group B and group C were divided into four subgroups: group B5, B10, B15, B20; and group C5, C10, C15, C20. Four experienced endoscopists performed conventional gastroendoscopy and diagnosed, if there was any lesion need biopsy, then the diagnosis was made after the pathological report back. After the examination, 2 independent investigators evaluated the mucosal visbility scores of six part s of the upper gastrointestinal tract. For each domain, the scoring(known as the visibility score) ranged from 1 to 4 according to the following system: 1, no adherent mucus on the mucosa; 2. a small amount of mucus on the mucosa, with no obscured vision; 3, a large amount of mucus on the mucosa, with less than 50 m L of water to clear; and 4, a large amount of mucus on the mucosa, with more than 50 m L of water to clear. The sum of the visibility scores for all six domains was considered the total MVS for each patient.2. To investigate whether cap-assisted colonoscopy cominbined with carbon dioxide would affect the colonscopy insertion rate and adenoma detection rate.From May 2014 to September 2014, a total of 841 patients enrolled for participation in the study. At last the eligible patients were 588. Patients underwent bowel preparation. Examinations were performed using a colonoscope with a distal tip diameter of 11.3 mm. Patients were randomly assigned to two groups, In the control group, air-insuf?ation colonoscopy uses judicious air insuf?ation to distend the colon during colonoscope insertion until the cecum is reached. On colonoscope withdrawal, air is used to adequately distend the colon to facilitate inspection. In cap-assisted combined with carbon dioxide colonoscopy group, The study method uses the combined approach of carbon dioxide distend the lumen of colon and insertion of cap-assisted colonoscopy. A transparent cap ?tted to the tip of the colonoscope. Colonoscopies and diagnosis were performed by four colonoscopists whose operation cases about 500-1000. Two research assistant measured insertion time.Results1. No gender/age differences among these groups, all baseline characteristics were well balanced between these groups. In group B, the mean of total MVS was 8.15±1.52, 7.96±1.53, 8.01±1.60, and 7.9.±1.67 for groups B5, B10, B15 and B20, respectively. Significant difference in the total MVS was found between group A(8.68±1.76) and groups B10, B15, B20(P<0.05), and there were no significant differences between the subgroups of group B and group C(P>0.05). The mean of total MVS in group C5 was 8.07±1.48, not significantly lower than that in group A(8.68±1.76)(P>0.05); However, in groups C10, C15, and C20, the mean of total MVS was 7.54±1.40, 7.71±1.54, and 7.46±1.31, respectively, significantly different from that in group A(P<0.05). Mucosal lesions detected in group B and group C(B5=19%,B10=18%,B15=19%,B20=19%,C5=16%,C10=18%,C15=22%, C20=22%) compared with group A(total 15 cases,17%)have not statistics differences(P>0.05). The MVS in all patients was 1.07±0.26 at the esophagus, 1.53±0.71 at the gastric fundus, 1.82±0.69 at the upper gastric body, 1.24±0.47 at the lower gastric body, 1.20±0.49 at the antrum, and 1.08±0.32 at the duodenum. The highest score belong to upper body and fundus of stomach.The MVS of gastric fundus, in groups B10(1.50±0.66), B15(1.55±0.72), B20(1.53±0.67), C10(1.42±0.66), C15(1.35±0.57), and C20(1.34±0.63) were signifi cantly different from that in group A(1.86±0.80)(P<0.05). However, there were no statistically significant differences between any pair of subgroups in group B and group C( P>0.05), and no significant diffrences among group A/B/C In other part of the uppe r gasrointestinal tract(P>0.05).2. The patients accepted conventional colonoscopy compared with the patients accepted cap-assisted combined with carbon dioxide insufflation colonscopy, there were no differences in gender, age(P>0.05).The intubation time in cap-assisted combined with carbon dioxide insufflation colonscopy group was much faster than control group(5.96±0.10 min vs. 6.63±0.11 min,P<0.01). The total polyps detection rateof group cap-assisted combined with carbon dioxide colonscopy(36.05%) was much higher thancontrol group(25.25%)(P<0.01). The diminutive polyps detection rate detected in the cap-assisted combined with carbon dioxide insufflation colonscopy group was much higher than control group(32.88% vs.23.55%, P<0.05), and the polyps detection rate in the right conlon also higher compared with control group(11.86% vs. 6.48%, P<0.05).Conclusions1. Premedication with simethicone combined with a 360-degree turn can improve the mucosal visibility during gastroendoscopy. The method of administration of the simethicone and immediately turned patients over then waiting for 10 min, may be the appropriate procedure for gastroendoscopy preparation. This mothod could improve the lesion detection rate under gastroendoscopy.2. Comparing with conventional colonscopy, cap-assisted combined with carbon dioxide insufflation colonscopy can reduce the intubation time and enhance the polyps detection rate, especially the diminutive polyps, our method also has advantage in detecting the right colon polyps. |
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