结肠镜检查肠道准备的临床更新

摘要(中文译文)

结肠镜检查对于结直肠癌（CRC）筛查至关重要，但其有效性取决于充分的肠道准备（BP），而高达44%的病例肠道准备仍不理想。肠道准备不佳会降低病变检出率，尤其是在近端结肠，并增加操作时间、重复检查次数和医疗费用。本叙述性综述总结了改善肠道准备的循证策略，重点介绍了高容量和低容量聚乙二醇（PEG）方案，包括患者耐受性更好的新型极低容量方案。西甲硅油和5-HT4受体激动剂等辅助药物对特定人群有益，尤其是便秘患者。分次剂量和当日方案，特别是检查前间隔小于5小时的方案，可提高肠道清洁度和腺瘤检出率。目前更推荐1天低纤维饮食，以提高依从性。肠道准备不佳的危险因素包括年龄、合并症和社会经济障碍。预测模型和人工智能应用程序等新兴工具有助于支持个性化医疗。以患者为中心、基于风险分层的策略对于优化结肠镜检查质量和降低结直肠癌发病率至关重要。

Abstract

Colonoscopy is essential for colorectal cancer (CRC) screening, but its effectiveness depends on adequate bowel preparation (BP), which remains suboptimal in up to 44 % of cases. Poor BP reduces lesion detection, particularly in the proximal colon, and increases procedure time, repeat exams, and healthcare costs. This narrative review summarizes evidence-based strategies to improve BP, highlighting high- and low-volume polyethylene glycol (PEG) regimens, including newer very-low-volume options with better patient tolerance. Adjunctive agents like simethicone and 5-HT4 agonists benefit select groups, especially those with constipation. Split-dose and same-day regimens, particularly with a <5-h interval before the procedure, enhance cleansing and adenoma detection. A 1-day low-fiber diet is now preferred for better compliance. Risk factors for poor BP include age, comorbidities, and socioeconomic barriers. Emerging tools, such as predictive models and AI-enabled apps, support personalized care. A patient-centered, risk-adapted approach is vital to optimize colonoscopy quality and reduce CRC incidence.

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