Inadequate Bowel Cleansing Efficacy of Split-dose Polyethylene Glycol for Colonoscopy in Type 2 Diabetic Patients
Inadequate Bowel Cleansing Efficacy of Split-dose Polyethylene Glycol for Colonoscopy in Type 2 Diabetic Patients
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DOI：
10.1097/mcg.0000000000000536
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发表时间：
2017-03-01
影响因子：
2.9
通讯作者：
Lee, Chang Won
中科院分区：
文献类型：
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作者：
Kim, Young Hwan;Seo, Eun Hee;Lee, Chang Won
背景/目的：分剂量聚乙二醇 (PEG) 被认为是普通人群结肠镜检查的标准肠道准备方案。然而，尚不清楚该方案是否是糖尿病患者结肠镜检查的最佳方案。本研究的目的是比较分次剂量 PEG 对糖尿病患者与非糖尿病患者的疗效和耐受性。方法：这是一项单中心、前瞻性、研究者盲法研究。总共 55 名连续的非糖尿病患者和 50 名糖尿病患者在手术前一天摄入 2L PEG 溶液，然后在结肠镜检查当天摄入 2L 溶液。采用渥太华量表对肠道准备质量进行分级。结果：糖尿病组肠道准备质量差异有统计学意义，除中结肠外准备较差（总分：7.06±1.69 vs. 5.54±1.97，P < 0.001；右结肠：2.28±0.57 vs. 1.81±0.72，P < 0.001；中结肠：1.70 +/- 0.54 对比 1.56 +/- 0.66，P = 0.253；直肠乙状结肠：1.70 +/- 0.76 对比 1.14 +/- 0.62，P < 0.001；液体量：1.38 +/- 0.53 对比 1.01 +/- 0.59，P = 0.001）。大约 70% 的非糖尿病患者做好了充足的准备，而糖尿病患者只有 40% 做好了充分的准备（P = 0.003）。糖尿病组盲肠插管时间较长（6.4 +/- 3.6 vs. 4.5 +/- 2.4，P = 0.002）和总手术时间（22.1 +/- 7.6 vs. 18.1 +/- 8.5，P = 0.015）。依从性和不良事件没有显着差异。在糖尿病组中，肠道准备不充分与较高的空腹血糖显着相关（136.9 +/- 21.8 vs. 121.8 +/- 19.4 mg/dL，P = 0.016）。结论：与非糖尿病患者相比，糖尿病患者的准备质量较差，盲肠插管和总手术时间较长。这些数据表明，分次剂量 PEG 准备方案不足以为接受结肠镜检查的糖尿病患者提供最佳肠道准备。
Background/Aims: Split-dose polyethylene glycol ( PEG) is considered a standard bowel preparation regimen for colonoscopy in the general population. However, it is not clear whether the regimen is optimal for colonoscopy in diabetic patients. The aim of this study was to compare the efficacy and tolerability of split-dose PEG for diabetic versus nondiabetic patients.Methods: This is a single-center, prospective, investigator-blinded study. A total of 55 consecutive nondiabetic and 50 diabetic patients ingested 2L PEG solution on the day before the procedure and then 2L of the solution on the day of colonoscopy. The quality of bowel preparation was graded using the Ottawa scale.Results: There was a significant difference in bowel preparation quality, with a worse preparation except for mid colon in diabetic group ( total score: 7.06 +/- 1.69 vs. 5.54 +/- 1.97, P < 0.001; right colon: 2.28 +/- 0.57 vs. 1.81 +/- 0.72, P < 0.001; mid colon: 1.70 +/- 0.54 vs. 1.56 +/- 0.66, P = 0.253; rectosigmoid colon: 1.70 +/- 0.76 vs. 1.14 +/- 0.62, P < 0.001; fluid volume: 1.38 +/- 0.53 vs. 1.01 +/- 0.59, P = 0.001). About 70% of nondiabetic patients had an adequate preparation compared with only 40% of diabetic patients ( P = 0.003). Diabetic group had longer cecal intubation time ( 6.4 +/- 3.6 vs. 4.5 +/- 2.4, P = 0.002) and total procedure time ( 22.1 +/- 7.6 vs. 18.1 +/- 8.5, P = 0.015). Compliance and adverse events were not significantly different. In diabetic group, inadequate bowel preparation had a significant association with higher fasting plasma glucose ( 136.9 +/- 21.8 vs. 121.8 +/- 19.4 mg/dL, P = 0.016).Conclusions: Diabetic patients had a worse preparation quality and longer cecal intubation and total procedure time compared with nondiabetic patients. These data suggest that split-dose PEG preparation regimen is not sufficient for optimal bowel preparation in diabetic patients undergoing colonoscopy.