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    Home > Active Ingredient News > Digestive System Information > How to improve the detection rate of adenomas under colonoscopy?

    How to improve the detection rate of adenomas under colonoscopy?

    • Last Update: 2021-05-09
    • Source: Internet
    • Author: User
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    It is only for medical professionals to read for reference.
    Can the detection rate of polyps be substituted for the detection rate of adenomas? How to improve the quality of bowel preparation? Recently, the "2021 Peking Union Medical College International Digestive Disease Forum and the 28th Peking Union Medical College Hospital Digestive Disease and Digestive Endoscopy Symposium" hosted by Peking Union Medical College Hospital, Beijing Branch of Chinese Medical Association, and Beijing Health Promotion Association were successfully held in Beijing.

    At the conference, Professor Bai Yu from the First Affiliated Hospital of Naval Military Medical University gave a wonderful report on the topic "How to improve the detection rate of colonoscopy adenoma?-Chang Hai's experience sharing".

    Increasing incidence? The key to preventing colorectal cancer lies in early screening.
    According to the latest domestic statistics, the incidence of colorectal cancer in my country is currently on the rise.
    The incidence has surpassed that of gastric cancer and ranks second in malignant tumors.

    Why does the incidence of colorectal cancer continue to rise? Professor Bai Yu pointed out that a large part of the reason is that many people do not know when to undergo colorectal cancer screening.
    Many people think that they have no obvious clinical symptoms and do not need to be tested.

    But is this really the case? Professor Bai Yu shared with us the data of colorectal cancer research done by the team in the past and found that more than 42% of colorectal cancer patients have no warning symptoms, and patients with obvious clinical symptoms are often diagnosed in the middle and advanced stages.

    Therefore, one cannot rely on whether the patient has clinical symptoms to determine whether a colonoscopy is needed.

    In addition, Professor Bai Yu also pointed out that it is difficult to judge whether there is colorectal cancer without colonoscopy, and the commonly used clinical cancer markers cannot predict early colon cancer.

    So, how to find early colorectal cancer and precancerous lesions? For colorectal cancer and gastrointestinal tumors, screening for the average risk and asymptomatic age population is the most effective way to detect early cancer.

    This is because the development process of colorectal cancer is very slow, about 15-20 years.
    Therefore, as long as the adenoma develops into an adenocarcinoma early detection and early resection, then the risk of the patient developing colorectal cancer will be obvious To fall.

    European and American research data found that the mortality rate of colorectal cancer dropped by 53% after the resection of colon adenoma.

    Figure 1: Colorectal cancer development process "Although European and American studies have shown that the mortality rate of colorectal cancer after colon adenoma resection has decreased significantly, it has not dropped to 0%, which means that there are still patients who have undergone colonoscopy.
    To become cancerous.

    ” Professor Bai Yu added.

    So, where is the problem? The missed diagnosis rate of colon adenoma is high, how can it be improved? A study published in gut showed that the short-term causes of colorectal cancer after endoscopic resection of polyps mainly include omission at the first examination (52%), new disease after complete resection (24%), and incomplete resection of the lesion (19%) ), biopsy is not allowed to misdiagnose (5%).

    A systematic review of 15,000 cases of back-to-back colonoscopy around the world found that the missed diagnosis rate of adenoma was 26%, and the missed diagnosis rate of pre-progressive adenoma was 9%.

    Professor Bai Yu pointed out that there are two main reasons for missed diagnosis of colon adenoma: Figure 2: Causes of missed diagnosis of colon adenoma.
    Adenoma detection rate is a very important item in the quality control index of colonoscopy, which improves the detection of colonoscopy.
    The rate is very important to reduce missed diagnosis of colon adenoma.

    Next, Professor Bai Yu shared the experience of Changhai Hospital on how to improve the detection rate of colonoscopy adenoma.

    1Can the detection rate of polyps be substituted for the detection rate of adenomas? ——Data from European and American countries show that the conversion coefficient of polyp detection rate instead of adenoma detection rate is 0.
    688, while the research data of Changhai Endoscopy Center shows that the conversion coefficient of polyp detection rate instead of adenoma detection rate is 0.
    483 , Less than 50%.

    Therefore, the detection rate of polyps cannot be substituted for the detection rate of adenomas.

    2Ensure the quality of bowel preparation-≥90% How to improve the quality of bowel preparation? First of all, we need to understand the reasons for poor bowel preparation.
    Studies have found that poor bowel preparation is related to constipation, not taking full laxatives, or taking a high-fiber diet 24 hours before colonoscopy. The existence of these risk factors is closely related to the patient's informed consent before endoscopy.
    Then, how to improve the patient's awareness of bowel preparation? Professor Bai Yu shared the experience of Changhai Hospital and regularly pushed the precautions for intestinal preparation to patients through WeChat public account, SMS and other methods.
    This method has achieved good results.

    Figure 3: WeChat and SMS improve the awareness of bowel preparations Professor Yu Bai reminds everyone that we can combine the characteristics of the endoscopy center to carry out diversified education to improve patients' awareness of bowel preparations.

    Secondly, the patient's diet management is also closely related to bowel preparation.

    How to improve diet management and improve bowel preparation compliance? The study found that the use of fully nutritious meal replacements to manage patients' diets can effectively improve patients' dietary compliance and bowel preparation scores.

    In addition, the study of Changhai Hospital found that chewing gum can improve the tolerance of patients to take laxatives.

    Figure 4: Chewing gum during bowel preparation can significantly improve patients' satisfaction with the bowel preparation process and improve the completion rate of bowel preparation.
    Professor Bai Yu emphasized that high-quality bowel preparation should include draining fluid and removing foam.

    In this regard, a study by Changhai Hospital found that the combination of laxatives and defoamers during intestinal preparation can significantly increase the rate of defoamers and the quality of intestinal preparation, and increase the detection rate of lesions.

    It is worth noting that the high FODMAP diet is related to poor intestinal preparation quality and increased bubbles.
    For such patients, dietary intervention should be taken earlier.

    3 Reasonable arrangement of colonoscopy work plan-fatigue may lead to a decrease in the detection rate of adenomas.
    A study from Changhai Hospital found that endoscopists are busy from morning to night, leading to the detection rate of colonoscopy and the success rate of intubation in the afternoon.
    Both were lower than the morning colonoscopy.

    4Improve the insertion rate of the ileocecal region-40% of Chinese patients with colon cancer/adenoma are located in the right colon.
    Dr.
    Bai Yu suggested that the endoscopy should be followed to the ileocecal region, and it is recommended to enter the terminal ileum for observation.
    The detection rate of lesions in this area is about It is 3%, and the detection rate of symptomatic patients is higher.

    5 Colonoscopy entry time-the shorter the better, Dr.
    Bai Yu suggested that under the condition of ensuring safety and patient comfort, improve the insertion level and shorten the entry time. In addition, the patient's posture has an effect on the time of entering the mirror.
    A study by Changhai Hospital found that the left side of the head low and the high foot can change the intestinal tract and angulation, which can shorten the time of entering the mirror and improve the comfort of the patient.

    Figure 5: The left head is lowered and the feet are in a high position while entering the lens in a horizontal position, which can also shorten the time of entering the lens and improve the comfort of the patient.

    Figure 6: 6 colonoscopy withdrawal time in supine position when entering the mirror-8-9 minutes Among the current quality control indicators of colonoscopy, the shortest withdrawal time is more than 6 minutes.

    However, is there an upper limit for the withdrawal time? Is the longer the better? Is there a "ceiling effect"? A prospective, multi-center, randomized, parallel-controlled clinical study involving 14 endoscopy centers across the country, including 1027 colonoscopy subjects, and comparing the detection rate of adenomas after 9 minutes of withdrawal and 6 minutes of withdrawal As a result, it was found that the detection rate of adenomas after 9 minutes of withdrawal was higher.

    Figure 7: Summary of the impact of 9 minutes and 6 minutes of withdrawal on the detection rate of adenomas: Finally, Professor Bai Yu concluded that how to detect colorectal cancer early has five main aspects: 1.
    Improve science education and make more People realize that screening can prevent colorectal cancer.

    2.
    Improve the quality of bowel preparation, such as diet management, the use of laxatives and defoaming agents.

    3.
    Improve the cecal insertion rate, ≥95%.

    4.
    Reasonable withdrawal time, 8-9 minutes.

    5.
    Make full use of the retracting technique to avoid omissions.

    Expert profileProfessor Yu Bai, Assistant Director, Associate Professor, Associate Chief Physician, Master Tutor of the Department of Gastroenterology, Changhai Hospital, Naval Military Medical University Member of the Youth Committee of the Chinese Society of Gastroenterology, Member of the Youth Committee of the Chinese Society of Digestive Endoscopy and Member of the Colonoscopy Group Shanghai Digestive Member of the Society of Diseases, National Excellent Doctoral Dissertation Winner (2012) Associate Editor of "Journal of Gastroenterology and Hepatology", "Chinese Journal of Digestion" Editorial Board of "Chinese Journal of Digestive Endoscopy", "Chinese Journal of Pancreatic Diseases", " "Gastroenterology" newsletter editor of Shanghai Shuguang, Shanghai Youth Science and Technology Venus, Shanghai Chenguang
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