| BackgroundThe gold standard for diagnosis and screening for colorectal cancer is colonoscopy,so it is very essential to improve the quality of colonoscopy.Presently,a lot of data based on related studies is still required to establish the standard practice of colonoscopy.Bowel preparation is an important criterion for colonoscopic quality,and some authors have shown that pre-procedural educational methods could improve the quality of bowel preparation.Furthermore,it is notable that colonoscopic quality improvement is also very necessary in special populations,and colonoscopy in older people,children and others are need to be studied.Method1.Factors influencing the quality of colonoscopyEligible patients who underwent colonoscopy was prospectively collected,the main outcome measurements included bowel preparation quality,polyps or adenoma detection rate,abdominal pain scores,cecum intubution time.2.Effect of cartoon educational booklet on bowel preparation qualityA cartoon educational booklet about bowel preparation was designed.Patients were assigned to control and cartoon groups in randomized,controlled way.And bowel preparation quality between two groups was assessed using Ottawa scores.3.Application of colonoscopy in patients aged older than 80 yearsPatients aged older than 80 years with complete data records were identified in the endoscopic database.Matched by gender(ratio,1:1),younger patients aged 18 to 80 years were assigned to younger group.The data regarding to completion rates,endoscopic finding were collected and compared between two groups.4.Application of pediatric colonoscopyPatients aged younger than 18 years with complete data records were identified in the endoscopic database.Matched by gender(ratio,1:1),patients aged older than 18 years were assigned to adult group.The data regarding to completion rates,endoscopic finding and adverse events were collected and compared between two groups.Result1.Factors influencing the quality of colonoscopyA total of 987 patients undergoing colonoscopy was analyzed.The rate of poor bowel preparation was 24.4%,and its independent risk factor was male(OR=1.51),medical history of constipation(OR=2.33),noncompliance with bowel preparation(OR=5.37),noncompliance with food intake before procedure(OR=1.42),fecal residue at the time of last stool before procedure(OR=2.09)and less defecating frequency(OR=1.10).During the colonoscopy,polyp detection rate was 27.9%and adenoma detection rate was 16.9%.Independent predictors of adenoma detection rate were male(OR=1.49),increased age(OR=1.03),compliance with bowel preparation(OR=4.15),prolonged withdrawal time(OR=1.20)and experience of operator with more than 100 cases(100 to 500 cases,OR=2.27;more than 500 cases,OR=1.96).The percentage of patients with moderate and severe abdominal pain during procedures was 51.3%,independent risk factors of which were female(OR=1.83),underweight(body mass index,BMI<18,OR=1.99).Average time of cecum insertion was 6.04 minutes,and the independent risk factors related to prolonged cecum insertion time included increased age(OR=1.02),constipation(OR=2.08)and lower BMI(BMI<24,OR=1.58),while anesthesia(OR=0.44)was significantly associated with shorter time of cecum insertion.2.Effect of cartoon educational booklet on bowel preparation quality314 patients in cartoon group and 313 patients in control group were allocated and analyzed.Educational cartoon booklet can significantly improve patients’compliance for bowel preparation(94.3%in cartoon group vs.87.9%in control group,p=0.005),patients’ understanding degrees of bowel preparation education(99.7%in cartoon group vs.97.4%in control group,p=0.019),the bowel preparation quality(83.8%in cartoon group vs.75.7%in control group,p=0.012),as well as polyp detection rates(36.9%in cartoon groupvs.28.4%in control group,p=0.023).3.Application of colonoscopy in patients aged older than 80 years786 patients were analyzed in each group.Primary indications for colonoscopy in very elderly patients were suspicious of gastrointestinal bleeding and occurrence of cancer.The completion rate of colonoscopy in elderly patients was lower(64.0%in the elderly group vs.90.2%in the younger group,p<0.001),but the diagnostic yield was higher(73.9%in the elderly group vs.55.7%in the younger group,p<0.001).Colorectal cancer was more common in the elderly group(20.9%)in comparison with younger group(5.2%)(p<0.001),especially located in left hemicolon.Endoscopic intervention rate was similar between two groups(21.0%vs.20.9%,p=0.951).4.Application of pediatric colonoscopy1781 patients were analyzed in each group.Pediatric colonoscopy had an equal diagnostic yield to adult colonoscopy(55.5%vs.55.9%,p=0.813),in spite of its evidently lower completion rate(81.9%vs.89.1%,p<0.001).Moreover,the most common finding in pediatric colonoscopy was intestinal polyps(20.2%),and with the most common location of rectum(36.7%)and the most common pathological diagnosis of juvenile polyps(42.5%),Adverse events all occurred after polypectomy procedure in both groups,and percentages of which were equivalent(1.0%vs.0.6%,p=0.176).ConclusionThe main factors affecting quality of colonoscopy include age,gender,body mass index,constipation,patients’ compliance and operators’ experience.Educational cartoon booklet can significantly improve the bowel preparation quality.Colonoscopy in very elderly patients,completion rate is lower,while with a high diagnostic yield,and the main indications are suspected hemorrhage or occurrence of cancer.Pediatric colonoscopy is a safety and effective examination,which is with an equivalent diagnostic yield to adult colonoscopy while its lower completion rate,and its most common finding is juvenile polyps in the rectum. |
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