Investigation Report Of Electronic Colonoscopy In Remote And Poor Areas

ObjectivesTo investigate the situation of e-colonoscopy in far poor and backward areas,analyze and discuss the related influencing factors,and explore the corresponding solutions and countermeasures,so that advanced digestive endoscopy technology can have better and faster development in similar far poor areas and help people in the frontier suffer from poverty and health.MethodsA total of 2129 colonoscopies were collected from all cases that underwent electronic colonoscopy in the gastroenterology department of the Lisu Autonomous Prefecture People’s Hospital of Nujiang during a 5-year period from January 2017 to December 2021.The data collected above were processed using Excel software,and the data were statistically analyzed using SPSS 19.0,As well as the results of age and sex distribution of colorectal disease in each category,the source of colonoscopy recipients,the detection of colorectal disease among symptomatic colonoscopy recipients and asymptomatic colonoscopy recipients,the related impact of e-colonoscopy in the lagged marginal areas of poverty,and the corresponding solutions and countermeasures should be discussed.Results1、General conditions: a total of 2129 subjects,including 1037 males(48.7%)and 1092 females(51.3%),who underwent electronic colonoscopy in the gastroenterology department of the people’s Hospital of Nujiang Lisu Autonomous Prefecture,Yunnan Province,between January 2017 and December 2021,were included in the study.The youngest age of subjects was 5 years and 10 months,the oldest age was 86 years,and the average age was 43 years.The ileocecal region was not reached in 176 cases(8.26%).Source of patients,1314 were outpatients,781 were inpatients,and 34 were in the physical examination center.Changes in person time of electronic colonoscopy between 5 years,with 54 total caseload of electronic colonoscopy in 2017,217 total caseload in 2018,382 total caseload in 2019,676 total caseload in 2020,and 800 total caseload in 2021,showing an overall upward trend year by year,with the number of painless electronic colonoscopies predominating,accounting for a rate of 87.4%.2、In all age groups,we divided the age groups into: < 18 years,18-45 years,46-60 years,and > 61 years with reference to the age division criteria of the World Health Organization,and the positive detection rate of large bowel disease was mainly distributed in the 18-45 year age group,and the total number of subjects in this age group was 1235,of whom 833 had detected large bowel disease,and the positive rate of enteroscopy in this age group was up to 39.1%(833 / 2129),Followed by 46-60 years old in this age group,the total number of subjects was 733,the number of subjects with enteroscopy detected large bowel disease was 263,and the positive rate of enteroscopy in this age group was 12.35%(263 / 2129),P < 0.05 by x2 test,with statistical significance.3、Detection profiles of various colorectal diseases in males and females.The majority of males had colorectal polyps and CRC,while the majority of females had inflammatory changes of the intestine and other diseases and colorectal polyps.Overall,the detection rate of male and female sex colorectal polyps,inflammatory changes of the intestine and other diseases was higher than that of other diseases.* P< 0.05,statistically significant by x2 test.4、Different kinds of colorectal disease were detected in males in each age group,CRC in males was mainly distributed in the age group of 46-60 years,with a positive rate of 1.22%,and colorectal polyps were mainly distributed in the age group of 18-45 years,with a positive rate of 12.35%,which was statistically significant by x2 test,P < 0.05.The inflammatory changes and other diseases in the intestine of male enteroscopy subjects were mainly distributed in the two age groups,18-45 years old and 46-60 years old,with positive rates of 5.35% and 3.43%,respectively,and no significant statistical significance was found for colonic melanosis in male subjects.5、Different kinds of colorectal disease were detected in women in each age group,CRC in women was mainly distributed in the age group of 18-60 years,the positive rate was 0.71%,colorectal polyps were mainly distributed in the age group of18-45 years,the positive rate was 7.61%,after x2 test,P < 0.05,statistical significance.6、Overview of the detection of large bowel disease in asymptomatic subjects,symptomatic subjects a total of 1356 individuals were detected,of whom 788 had large bowel disease detected,giving a disease detection rate of 58.1%(788 / 1356),asymptomatic subjects a total of 773 had large bowel disease detected,320 had disease detection rate of 41.4%(320 / 773),and the positive detection rate was much higher in symptomatic subjects than in asymptomatic subjects,The positive detection rate was still higher in asymptomatic subjects,which was statistically significant by x2 test,P < 0.05.7、Costs and Medicare payments for electronic colonoscopy,which costs $270 /person for plain electronic colonoscopy and $585 / person for painless electronic colonoscopy(which includes anesthesia costs of $315 / person).The costs described above are out of pocket for outpatients,and reimbursable on a Medicare scale for inpatients.According to Nujiang statistical yearbook 2021,the per capita disposable income of permanent residents in both urban and rural areas of Nujiang increased faster in 2017-2021,but the ranking was still penultimate within the 16 Prefecture states of Yunnan Province,and correspondingly,residents were also extremely low in their health care consumption index.8、Enteroscopy subject source profile,rate of enteroscopy subjects by calendar year for the total population of irritable Jiang state.Source of patients,1314 outpatients,781 inpatients and 34 subjects from physical examination center,the source of physical examination center was particularly small,most of the subjects came from outpatient clinics.The rate of enteroscopy recipients over the calendar year for the total population of Nujiang Prefecture,which is derived from Yunnan Province statistical yearbooks,increased to an average of 1 per 10 000 in Nujiang Prefecture in2017 who underwent enteroscopy,which was substantially lower than the national average by 2021.Conclusions1、The low per capita disposable income of the people in the region,the low consumption index in terms of residential health care,the insufficient measures for the citizens on digestive endoscopy,the lack of enthusiasm and economic ability of the populace on health examination,the recommendation of giving policy support in the field of colorectal cancer prevention and treatment,and the introduction of related measures for the citizens.2、Digestive endoscopy equipment is lagging behind in this region,and digestive endoscopy specialists are lacking.The superior management department should cultivate excellent digestive endoscopy talents for the hospital and configure excellent medical facilities and equipment for digestive endoscopy.3、The region has a high detection rate of colorectal disease,with a very low detection rate among individuals at high risk for CRC targets.It is recommended that the government department of the territory advance ’screening for colorectal cancer in poor areas’ as a major public health service programme with a free preferential policy for individuals at high risk of the screened out CRC target in order to promote enthusiasm for testing in individuals at high risk of developing CRC.4、The overall detection rate of digitonic colonoscopy is extremely low.Dissecting the factors associated with adherence,it is believed that popular science preaching for people in outlying and poor areas,promoting painless electronic enteroscopy comfort diagnosis and treatment,etc.,should be strengthened to improve the compliance of enteroscopy among local people.