肠镜检查时冲洗策略应用的临床研究

doi:10.16139/j.1007-9610.2026.02.07

外科理论与实践 ›› 2026, Vol. 31 ›› Issue (02): 137-143.doi: 10.16139/j.1007-9610.2026.02.07

肠镜检查时冲洗策略应用的临床研究

张雅婧¹, 陶逸凡^*, 潘彤¹, 陶丁霞²(), 戴彦成³(), 赵航¹()

¹ 上海中医药大学附属市中医医院消化内科，上海 200071
² 上海市青浦区中医医院脾胃病科，上海 201700
³ 上海市中西医结合医院消化内科，上海 200082

收稿日期:2025-04-29 出版日期:2026-04-25 发布日期:2026-06-23
通讯作者: 赵航，E-mail: zhaohang@shutcm.edu.cn; 戴彦成，E-mail: daiyancheng2005@163.com; 陶丁霞，E-mail: taodingxia@163.com
作者简介:作者贡献/Authors’ contributions
张雅婧负责研究设计、资料收集和撰写；陶逸凡负责统计数据和撰写；潘彤负责文献查阅及资料收集；陶丁霞负责研究设计、审校和提供意见；戴彦成负责研究设计、审校和修改；赵航负责指导研究设计、撰写和修改。所有作者均阅读并确认最终稿。
*共同第一作者
基金资助:
上海市级医院消化内科专科联盟诊疗技术推广及优化管理项目(SHDC22024302)

Clinical research on the application of flushing strategy during colonoscopy

ZHANG Yajing¹, TAO Yifan^*, PAN Tong¹, TAO Dingxia²(), DAI Yancheng³(), ZHAO Hang¹()

¹ Department of Gastroenterology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200071, China
² Department of Gastroenterology, Shanghai Qingpu Hospital of Traditional Chinese Medicine, Shanghai 201700, China
³ Department of Gastroenterology, Shanghai Traditional Chinese Medicine-Integrated Hospital, Shanghai 200082, China

Received:2025-04-29 Online:2026-04-25 Published:2026-06-23

摘要/Abstract

摘要：

目的：初步探讨肠镜检查时不同冲洗策略对于操作时间和息肉发现率（PDR）的影响。方法：采用多中心前瞻对照入选的方法，筛选2023年8月至2024年1月在三家医院接受肠镜检查的248例病人作为研究对象，随机分配进入研究组和对照组。研究组和对照组在肠镜检查时分别采用彻底冲洗策略和有限冲洗策略，记录并评估两组的一般临床资料、内镜操作时间及息肉发现情况。结果：共248例入组，其中研究组125例，对照组123例。两组基线数据具有可比性。研究组PDR显著高于对照组（P<0.01），发现息肉的病人中，研究组左半结肠小息肉发现例数高于对照组（P<0.05）。结论：肠镜冲洗策略有助于提高PDR，提高左半结肠小息肉发现数量，且不增加检查的总时间。

关键词: 肠镜, 肠道准备, 冲洗, 息肉发现率, 质量控制

Abstract:

Objective To investigate the impact of different flushing strategies on procedure time and polyp detection rate(PDR) during colonoscopy. Methods A multicenter prospective controlled study was conducted, enrolling 248 patients who underwent colonoscopy at three hospitals from 2023 August to 2024 January. The patients were assigned to research group and control group randomly. The research group received a thorough flushing strategy during colonoscopy, while the control group received a limited flushing strategy. Clinical data, endoscopic procedure time, and polyp detection results were recorded and compared between the two groups. Results A total of 248 patients were enrolled, with 125 in the research group and 123 in the control group. Baseline characteristics were comparable between the two groups. The research group demonstrated a significantly higher PDR compared to the control group (P<0.01). Among patients with detected polyps, the research group detected more small polyps in the left colon than the control group (P<0.05). Conclusions The flushing strategy during colonoscopy improves PDR and increases the detection of small polyps in the left colon without prolonging the total procedure time.

Key words: Colonoscopy, Bowel preparation, Flushing, Polyp detection rate(PDR), Quality control

中图分类号:

R473.5

张雅婧, 陶逸凡, 潘彤, 陶丁霞, 戴彦成, 赵航. 肠镜检查时冲洗策略应用的临床研究[J]. 外科理论与实践, 2026, 31(02): 137-143.

ZHANG Yajing, TAO Yifan, PAN Tong, TAO Dingxia, DAI Yancheng, ZHAO Hang. Clinical research on the application of flushing strategy during colonoscopy[J]. Journal of Surgery Concepts & Practice, 2026, 31(02): 137-143.

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参考文献 20

[1]	KAWAMURA T, SEKIGUCHI M, TAKAMARU H, et al. “Endoscopic” adenoma detection rate as a quality indicator of colonoscopy: first report from the J-SCOUT study[J]. Dig Endosc, 2023, 35(5):615-624. doi: 10.1111/den.v35.5 URL
[2]	JACOBSON B C, ANDERSON J C, BURKE C A, et al. Optimizing bowel preparation quality for colonoscopy: consensus recommendations by the US multi-society task force on colorectal cancer[J]. Gastroenterology, 2025, 168(4):798-829. doi: 10.1053/j.gastro.2025.02.002 pmid: 40047732
[3]	KIM S H, KIM O Z, YOO I K, et al. Second examination of the right colon using narrow-band imaging increases adenoma detection rates in the right colon: a multicenter, randomized controlled trial[J]. J Gastroenterol Hepatol, 2025, 40(7):1667-1674. doi: 10.1111/jgh.v40.7 URL
[4]	TSENG C W, HSIEH Y H, KOO M, et al. Comparing right colon adenoma detection rate during water exchange and air insufflation: a double-blind randomized controlled trial[J]. Tech Coloproctol, 2022, 26(1):35-44. doi: 10.1007/s10151-021-02537-1
[5]	KALTENBACH T, GAWRON A, MEYER C S, et al. Adenoma detection rate (ADR) irrespective of indication is comparable to screening ADR: implications for quality monitoring[J]. Clin Gastroenterol Hepatol, 2021, 19(9):1883-1889. doi: 10.1016/j.cgh.2021.02.028 URL
[6]	ZHAO S, WANG S, PAN P, et al. Magnitude, risk factors, and factors associated with adenoma miss rate of tan-dem colonoscopy: a systematic review and meta- analysis[J]. Gastroenterology, 2019, 156(6):1661-1674. doi: 10.1053/j.gastro.2019.01.260 URL
[7]	SHAHINI E, SINAGRA E, VITELLO A, et al. Factors affecting the quality of bowel preparation for colonoscopy in hard-to-prepare patients: evidence from the literature[J]. World J Gastroenterol, 2023, 29(11):1685-1707. doi: 10.3748/wjg.v29.i11.1685 URL
[8]	LIU W Q, SHU L, ZHOU X, et al. Evaluation of the efficacy of polyethylene glycol in combination with different doses of linaclotide in a fractionated bowel preparation for colonoscopy: a prospective randomized controlled study[J]. Int J Colorectal Dis, 2024, 39(1):143. doi: 10.1007/s00384-024-04718-4
[9]	中华医学会消化内镜学分会结直肠学组. 结肠镜检查肠道准备专家共识意见(2023, 广州)[J]. 中华消化内镜杂志,2023, 40(6):421-430.
	Colorectal Group, Digestive Endoscopy Branch of Chinese Medical Association. Consensus on bowel preparation for colonoscopy (2023, Guangzhou)[J]. Chin J Dig Endosc,2023, 40(6):421-430.
[10]	KASTENBERG D, BERTIGER G, BROGADIR S. Bowel preparation quality scales for colonoscopy[J]. World J Gastroenterol, 2018, 24(26):2833-2843. doi: 10.3748/wjg.v24.i26.2833 URL
[11]	FAVERI M C, SOUZA D, ZUNIGA I, et al. Enhanced instructions for inpatients undergoing colonoscopy: a systematic review and meta-analysis of randomized controlled trials[J]. J Surg Res, 2025,314:229-239.
[12]	NIEDERMAIER T, AMITAY E L, GIES A, et al. Impact of inadequate bowel cleansing on colonoscopic findings in routine screening practice[J]. Clin Trans Gastroenterol, 2020, 11(4):e00169. doi: 10.14309/ctg.0000000000000169 URL
[13]	BHURWAL A, RATTAN P, SARKAR A, et al. A comparison of 9-min colonoscopy withdrawal time and 6-min colonoscopy withdrawal time: a systematic review and meta-analysis[J]. J Gastroenterol Hepatol, 2021, 36(12):3260-3267. doi: 10.1111/jgh.v36.12 URL
[14]	徐起, 宫爱霞, 张经文, 等. 退镜时间对结肠息肉检出率影响的研究[J]. 中华消化内镜杂志, 2019, 36(12):936-938.
	XU Q, GONG A X, ZHANG J W, et al. Effect of withdrawal time on colon polyp detection rate[J]. Chin J Dig Endosc, 2019, 36(12):936-938.
[15]	BRONZWAER M E S, GREUTER M J E, BLEIJENBERG A G C, et al. Impact of differences in adenoma and proximal serrated polyp detection rate on the long-term effectiveness of FIT-based colorectal cancer screening[J]. BMC Cancer, 2018, 18(1):465. doi: 10.1186/s12885-018-4375-9 pmid: 29695244
[16]	PARK S H, HONG K I, PARK H C, et al. Colonic polyp study: differences in adenoma characteristics based on colonoscopy history over 5-year follow-up period[J]. J Clin Med, 2024, 14(1):194. doi: 10.3390/jcm14010194 URL
[17]	JUNG Y, CHA J M, LEE N H, et al. Impact of endoscopists' personality traits on adenoma and polyp detection rates in colonoscopy: a kasid multicenter study[J]. Dig Dis Sci, 2020, 65(8):2302-2310. doi: 10.1007/s10620-020-06158-w
[18]	NG S, SREENIVASAN A K, PECORIELLO J, et al. Polyp detection rate correlates strongly with adenoma detection rate in trainee endoscopists[J]. Dig Dis Sci, 2020, 65(8):2229-2233. doi: 10.1007/s10620-020-06049-0
[19]	FACCIORUSSO A, BUCCINO V R, TONTI P, et al. Impact of fellow participation on colon adenoma detection rates: a multicenter randomized trial[J]. Gastrointest Endosc, 2020, 92(6):1228-1235. doi: 10.1016/j.gie.2020.05.015 pmid: 32433915
[20]	HASSAN C, SPADACCINI M, IANNONE A, et al. Performance of artificial intelligence in colonoscopy for ade-noma and polyp detection: a systematic review and meta-analysis[J]. Gastrointest Endosc, 2021, 93(1):77-85,e6. doi: 10.1016/j.gie.2020.06.059 URL

	Research group （n=125）	Control group (n=123)	Statistical value	P value
Age (years)	57.7±12.7	54.6±13.3	1.893	0.059 6
Sex				0.075 0
Male	72（57.6）	56（45.5）
Female	53（42.4）	67（54.5）
Source
Outpatient	75（60.0）	84（68.3）		0.187 4
Inpatient	50（40.0）	39（31.7）		0.187 4
Examination（%）
symptoms	49（39.2）	47（38.2）		0.069 1
screening	52（41.6）	64（52.0）
follow-up	24（19.2）	12（9.8）
Chronic disease
Yes	21（16.8）	25（20.3）		0.515 9
No	104（83.2）	98（79.7）		0.515 9
Colonoscopy history
Yes	37（29.6）	24（19.5）		0.077 1
No	88（70.4）	99（80.5）		0.077 1
BBPS	7.8±0.6	7.7±1.1	0.406 7	0.685 7

Item	Research group （n=125）	Control group (n=123)	t value	P value
Total procedure time（s）	847.9±454.4	779.5±358.7	1.314	0.190 1
Cecal intubation time（s）	316.0±240.0	303.5±199.3	0.445	0.657 1
Withdrawal time（s）	532.0±227.8	476.0±174.1	2.169	0.031 0
Number of segments with fluid pooling	4.0±0.9	3.78±1.04	1.933	0.054 4
Volume of irrigation fluid uesd（mL）	180.6±124.9	97.4±47.0	6.924	<0.000 1
BBPS	7.9±0.7	7.8±0.6	0.8118	0.417 7

Item	Research group （n=125）	Control group (n=123)	t value	P value
Number of patients with polyps	90（72.0）	34（27.6）		<0.01
Number of polyps found（per case）	2.2±1.8	1.9±1.0	0.8831	0.378 9
Single	40(32.0）	14(11.4)		0.840 0
Multiple	50(40.0)	20(16.3)
Morphology(total number of cases）				0.559 3
Ⅰ	27（21.6)	8(6.5)
Ⅱ	49(39.2)	22(17.9)
Ⅲ	13(10.4)	3(2.4)
Ⅳ	22(17.6)	5(4.1)
Location of the polyp				0.252 8
Right colon	35(28.0)	19(15.4)
Left colon	61(48.8)	21(17.1)
Number of patients with small polyps	52(41.6)	18(14.6)		0.687 0
Number of small polyps found				>0.999 9
Single	15(12.0)	5(4.1)
Multiple	37(29.6)	13(10.6)
Morphology of the small polyps				0.803 4
Ⅰ	14(11.2)	5(4.1)
Ⅱ	35(28.0)	14(11.4)
Ⅲ	6(4.8)	1(0.8)
Ⅳ	11(8.8)	2(1.6)
Location of small polyp				0.032 3
Right colon	16(12.8)	12(9.8)
Left colon	40(32.0)	9(7.3)

肠镜检查时冲洗策略应用的临床研究

Clinical research on the application of flushing strategy during colonoscopy

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