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Effect of dynamic position changes during colonoscope withdrawal: a meta-analysis of randomized controlled trials

机译：在结肠镜撤离过程中动态位置变化的影响：随机对照试验的荟萃分析

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摘要

Background Colonoscopies are considered to be the primary screening test and gold standard test for colorectal cancer. Position changes during colonoscope withdrawal are believed to be associated with an increased adenoma detection rate (ADR) and polyp detection rate (PDR). However, previous results conflicted, and this study aimed to elucidate the effectiveness of dynamic position changes during colonoscope withdrawal. Methods The relevant publications were identified by searching the medical databases. The primary outcomes were the ADR and PDR, which were pooled and analyzed. The secondary outcome was the withdrawal time. The studies that supplied the ADR and PDR for different segments of the colon were separated into subgroup analyses. Results Five randomized controlled trials were eligible for analysis. The total ADR was higher with dynamic position changes than with a static position (odds ratio, [OR] 1.34; 95% confidence interval [CI] 1.13-1.59; p < 0.001), with low evidence of between-study heterogeneity (I-2 = 0%). Although the total PDR was slightly higher with dynamic position changes than with a static position (OR 1.23; 95% CI 0.88-1.73), there difference was not statistically significant (p = 0.22). The withdrawal time was only increased by 0.47 min (95% CI - 0.11 to 1.06) with dynamic position changes, without statistical significance (p = 0.11). The subgroup analysis showed that the ADR and PDR for the transverse colon were higher with dynamic position changes, with pooled estimates of ADR (OR 1.72; 95% CI 1.02-2.88; p = 0.04) and PDR (OR 1.79; 95% CI 1.08-2.96; p = 0.02). Conclusion Dynamic position changes during colonoscope withdrawal increased the total ADR; however, no obvious increase was found in the total PDR. The withdrawal time was not significantly prolonged with dynamic position changes. Subgroup analysis showed that the ADR and PDR in the transverse colon were obviously improved with dynamic position changes.
机译：背景结肠镜检查被认为是结直肠癌的主要筛查试验和金标准试验。结肠镜撤检期间的体位变化被认为与腺瘤检出率（ADR）和息肉检出率（PDR）增加有关。然而，之前的结果相互矛盾，本研究旨在阐明结肠镜退出期间动态位置变化的有效性。方法检索相关文献。主要结果是ADR和PDR，这两项结果被汇总和分析。次要结果是停药时间。将为不同结肠段提供ADR和PDR的研究分为亚组分析。结果5个随机对照试验符合分析条件。动态体位改变的总ADR高于静态体位（优势比[OR]1.34；95%可信区间[CI]1.13-1.59；p<0.001），研究间异质性证据较少（I-2=0%）。虽然动态体位改变的总PDR略高于静态体位（OR 1.23；95%可信区间0.88-1.73），但差异无统计学意义（p=0.22）。停药时间仅增加了0.47分钟（95%可信区间-0.11至1.06），且位置发生动态变化，无统计学意义（p=0.11）。亚组分析显示，动态位置改变时，横结肠的ADR和PDR较高，ADR（OR 1.72；95%可信区间1.02-2.88；p=0.04）和PDR（OR 1.79；95%可信区间1.08-2.96；p=0.02）的综合估计值较高。结论结肠镜停镜过程中体位的动态变化增加了不良反应的总发生率；然而，总PDR没有明显增加。动态体位改变不会显著延长停药时间。亚组分析显示，动态体位改变可明显改善横结肠的ADR和PDR。

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  • 来源
    《Surgical Endoscopy》 |2021年第3期|共11页
  • 作者

    Li Peiwen; Ma Bin; Gong Shulei; Zhang Xinyu; Li Wenya;

  • 作者单位

    China Med Univ Dept Thorac Surg Hosp 1 155 North Nanjing St Shenyang 110001 Peoples R China;

    China Med Univ Liaoning Canc Hosp &

    Inst Dept Colorectal Surg Canc Hosp 44 Xiaoheyan Rd;

    China Med Univ Dept Thorac Surg Hosp 1 155 North Nanjing St Shenyang 110001 Peoples R China;

    China Med Univ Dept Thorac Surg Hosp 1 155 North Nanjing St Shenyang 110001 Peoples R China;

    China Med Univ Dept Thorac Surg Hosp 1 155 North Nanjing St Shenyang 110001 Peoples R China;

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  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 诊断学;
  • 关键词

    Dynamic position changes; Adenoma detection rate; Polyp detection rate; Colonoscopy;

    机译：动态位置变化;腺瘤检出率;息肉检出率;结肠镜检查;

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