2024中国肠道准备指南解读及研究进展

中国肠道准备指南解读及研究进展10081.67055.547.941.630肺癌

结肠癌

胃癌

乳，腺癌

肝癌中国癌谱变化按癌定发病数计算，排名前五的癌症依次为肺癌、结直肠癌、感、乳家癌、肝癌，肺癌仍然是我国最高

发的癌症，据估计，2020年中国新增肺癌病例81万。结直肠癌发病数超起过胃癌位居第二；乳腺癌取代

肝癌成为第四顺位常见癌。我国CRC

发病情况Changing

profilesofcancerburdenworldwideand

inChina:

asecondaryanalysisoftheglobalcancerstatistics2020发病率/10万人4190如何发现早期结肠癌?适龄、无症状、平均风险人群筛查首次检查时遗漏

(52%)完整切除后新发

(24%)病灶切除不完整

(19%)活检失败误诊断

(5%)25.4deaths

pExpected

from

general

population(SEER9)12

deathsObservedadenomacohortObservedNPSnonadenomacohort0.0中024

6

8

10

12

14161820结肠镜对结肠癌的预防价值结肠镜检查后发生结肠癌的原因结肠镜可使结肠癌死亡率下降≥50%Gut.2014;63(6):949-56.N

Engl

J

Med.2012;366(8):687-96.1.6-1.4-

1.2-1.0-

0.8-0.6-0.4-

0.2-CumulatveColorectalCancerMortalityYears

FollowedNPSSERRATEDLESIONSho

DAPPCGastroenterologyProtumorigenicImmuneNetworksinHCC18901617

Mucoalmpdncan

aphagpalone1717

UseofFibraScan

in

Patiens

Wt

NAFLD1761poleofTGFandjNKSgnlng

in

EsophpealCrdnopeness1849HoatmmuneBauonbyHCCBoleofpDuIF=20.7结肠胰腺癌漏诊率有多高?ZhaoSB,BaiY,LiZS.Gastroenterology.2019;156:1661-1674.ADR

APPC

APIC结肠腺癌漏诊原因患者因素肠道准备

看得清医生因素操作技术

看得全肠道准备质量与结肠病变发现率理想的肠道准备理想肠道准备柏愚，李兆申.中国早期结直肠癌筛查及内镜诊治指南.中华消化内镜杂志.2015;32(6):1-20.现实肠道准备Impactof

coloniccleansingonqualityanddiagnosticyield

ofcolonoscopy:the

European

Panel

of

Appropriateness

ofGastrointestinalEndoscopyEuropeanmulticenterstudyFlorianFrochlich,MD,VincentWietlisbach,BAt,JeanJacquesGonvers,MD,BernardBurnand,MD,MPH,John-PaulVader,MD,MPHLausanne

and

Basle,Switzerland

11个欧美国家21家内镜中心，5,832例结肠镜进境时间肠道准备不理想的影响中华内科杂志2019年7月第58卷第7期Chin

J

Intern

Med,July2019,Vol.58,No.7中国消化内镜诊疗相关肠道准备指南(2019,上海)1肠道准备的目的和要求5

祛炮剂2患者告知及患教6

口服肠道清洁剂禁忌症3饮食限制7特殊患者的肠道准备4肠道清洁剂选择和用法8

小肠镜和胶囊内镜指南主要内容肠道准备目的和要求Adler

etat,201312.0%1.56(3)Aslanianetal,20131.1%1.39

(0.33,5.86)Chilu

etal,201112.5%1.16(0.86,1.57)deJongoet

at,201210.4%2.13(1.49,3.03)Froehlichetat,200513.3%1.46(1.11,1.93)Jover

etal,201373%1.35

(0.84,2.16)Porez

etal,201172%1.45(0.90,2.34)Aadaelliet

at

200819.6%1.10(0.96,1.26)Sherer

etat,201216.6%1.52(1.24,1.86)Total

(95%CI)-0.-18.11.100.0%-.1.41[1.21,1.64]推荐1:内镜医师应在结肠镜操作过程时评估患者肠道准备情况，医疗机构应定期监测肠道准备合格率Meta:

高质量肠道准备的ADR

比低质量肠道准备高41%StudyorSubgroupWeightOddsRato,95%COddsRatio,95%CI证据质量：低；推荐强度：强02

0.5Favors

FayorgLow-quality

High-qualityAmJGastroenterol.2014;109(11):1714-23Haterogeneity:²03:²df

8(P=0

02);²=56%Testfor

overall

effect

Z=435(P<0.0001)0.1Comprehensive

validation

ofthe

Boston

Bowel

Preparation

ScaleAudrey

H.Calderwood,MD,Brian

C.Jacobson,MD,MPH,FASGEBoston,Massachusetts,USAGastrointest

Endosc2010;72:686-92.肠道准备目的和要求ORIGINAL

ARTICLE:Clinical

Endoscopy推荐2:采用波士顿量表或渥太华评估肠道准备情况证据质量：高；推荐强度：强波士顿量表评分标准0由于无法清除的固体或液体粪便导致整段黏膜无法观察(A)1由于污斑、混浊液体、残留粪便导致部分黏膜无法观察(B)2肠道黏膜观察良好，但残留少量污斑、混浊液体、粪便(C)3肠道黏膜观察良好，基本无残留污斑、混浊液体、粪便(D)肝曲、横结肠、脾曲总分降结肠、乙状结肠、直肠波士顿肠道评分量表盲肠、升结肠推荐3:肠道准备前应向患者提供口头联合书面的详细指导，并强调依从的重要性，有条件的单位可联合电话，短

信和微信等辅助方式指导患者进行肠道准备患者告知及宣教Telephone-basedre-educationon

the

daybeforecolonoscopy

improves

the

qualityof

bowel

preparationandthe

polypdetection

rate:a

prospective,colonoscopist-blinded,randomised,controlledstudyXiaodong

Liu,'Hui

Luo,'Lin

Zhang,'Felix

WLeung,?³Zhiguo

Liu,'Xiangping

Wang,'Rui

Huang.'Na

Hu,'Kaichun

Wu,Daiming

Fan,Yanglin

Pan,'Xuegang

Guo¹EffectofWeChatandshortmessageserviceonbowelpreparation:anendoscopist-blinded,randomizedcontrolled

trialShuUng

Wang'.Oan

Wang',Jun

Yao,Sheng-BngZhao",USheng

Wang.Zhao

ShenU

and

YuBat证据质量：高；推荐强度：强

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o

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Leung.Hui

Luo.'Limei

Wang.'JWu.'Xiaoyang

Guo.

Xiangping

Wang."Lnhui

Zhang.NaHui;Oin

Tao,"Hui

Jia,ZhiguoLu,ZhangqinChen,

JunjunLiu,'KaichunWu,DaimingFan,YanglinPan,andXuegangGuo*sysnMATICRviWANDMETA-ANAIMsisDeliveryofInstructionsvia

MobileSocial

Media

AppIncreasesQualityof

Bowel

Preparation⑩◆肠道准备的意义，重要性◆泻药使用的时间，剂量及方法◆饮食限制的时间和要求◆其他措施的应用◆强调依从性的重要性◆出现不良反应的应对措施<结肠镜检查准备须知取消关注填写预约信息

历史消息

常见问题患者告知及宣教术前宣教内容危险因素(N=409)OR95%CIP

value便秘2.051.31-3.230.002未

全

量

服

用

P

E

G2.771.47-5.210.002肠镜前24h高纤维饮食2.151.40-3.28<0.001OriginalarticleConstipation,fiberintake

andnon-compliancecontributetoinadequatecolonoscopybowelpreparation:aprospectivecohort

study肠道准备不佳的比例：36.4%长海医院消化内镜中心患者肠道准备不佳的原因FangJ,BaiY,LiZS.JDigDis.2016;17;458-46310090798070608

5040313017.5207.51010肠道准备肠道准备是肠镜受检者最大的负担其他

没有

未说明NicholsonFB,ctal.JMod

Scroon.2005:12:89-95乙状结肠镜

结肠镜7.5

24

2恢复操作过程焦虑尴尬25255551最痛苦的就是喝电解质的过程

刚喝完泻药，真的无比难喝，喝到后来直接吐于是接着一直喝到见底，快吐了

其实做肠镜还好，就是灌肠药比较难喝。最烦人的就是泻药了，真的很恶心，聚乙二醇喝吐了，明早还要喝三大杯清肠的药喝不下去怎么办，吐了两次了太难喝了，特别是磷酸钠盐闻着像雪碧，可是太咸了，我差点吐了这个味道，喝一口一路苦涩到胃子里，恶心的要死泻药味道太诡异，喝水太撑提高患者对肠道准备的依从性●

肠道准备时恶心呕吐，腹胀等不良反应波动20-25%左右●

症状严重者影响肠道准备效果，降低今后复查结肠镜的意愿喝泻药难受还是排泄难受?答案是：喝泻药难受，满满三升啊!整个肠镜过程中，最难过的就是喝泻药服用泻药

肠镜检查中的疼痛肠道清洁剂分类指南推荐内容聚乙二醇(PEG)电解质散3L

PEG的分次剂量方案可提供高质量的肠道清洁；镁盐硫酸镁可作为常用肠道清洁剂，肾功能异常、炎症性肠病者避免使用磷酸钠不常规使用口服磷酸钠进行肠道准备，口服磷酸钠前应先评估肾功能匹可硫酸钠复方匹可硫酸钠可用于内镜检查前的肠道准备，耐受性较好甘露醇不建议治疗性结肠镜使用甘露醇进行肠道准备番泻叶原叶、蓖麻油中草药制剂应与其他肠道清洁剂联合使用以减少不良反应肠道清洁剂的分类根据《中国消化内镜诊疗相关肠道准备指南(2019,上海)》,肠道清洁剂主要分为以下几种：EffectofWeChatandshortmessageservice

on

bowel

preparation:

anendoscopist-blinded,randomizedcontrolledtrialShuLngWang',QianWang",JunYao*,Sheng-BngZhao°,UShengWang,Zhao-ShenLandYuBar●

国内，单中心，前瞻性，随机对照研究●

436例结肠镜前接受肠道准备患者●

常规+微信vs.常规+短信vs.常规微信组患者肠道准备质量优于短信组

微信组和短信组均优于常规组患者告知及宣教WangSL,

BaiY,LiZS,etal.EurJGastroenterolHepatol.2019,31(2).170-177.饮食限制MedicineSvsnMATicRevEWANDMHIA-AsALysisPENRegimefor

Bowel

Preparation

in

Patients

ScheduledtoColonoscopy:Low-Residue

Diet

or

Clear

Liquid

Diet?

Evidence

FromSystematic

ReviewWith

PowerAnalysisGmo-MinSomg.BS.Xin

Tian.AIN.

UMa.MN,LUJwnM.MN.TingShnat.AIN.云

Zcng.MN,amd

Xian-Tao

Zeng

MD推荐4:术前采用低渣/低纤维饮食，饮食限制一般不超过24h证据质量：高；推荐强度：强证据质量：高；推荐强度：强Low-residueversusclearliquiddietbeforecolonoscopy:m,omily

T

Nanon

mo

sab

pan

Mp.Inine.(ahbonuhocu.mwkOlumbus.Moocsunt.tsA推荐5:亦可采用术前1天清洗流质饮食SYSTEMATCREVIEWANDMETA-ANALYSISimpact

of

dietliberalization

on

bowel

preparationcolonoscopyameta-analysisof

randomized,controlledtrialsg0TheforOttawabowel饮食限制●

中国台湾地区，单中心，前瞻性，观察性研究●804例肠道准备患者。书面指导饮食并记录●

评估实际饮食含渣量对肠道准备效果的影响●

只有44.2%患者最终严格遵守饮食指导建议Impact

of

Low-Residue

Diet

on

Bowel

PreparationforColonoscopy含渣量越高肠道准备合格率越低Dietary

residue

content

Dietary

residue

content

score加强饮食管理，提高肠道准备依从性中华消化内镜杂态2019年12月第36卷第12期

ChinJDgFnkac,Decmber2019,Val,36,Noa12低渣全营养配方粉在结肠镜肠道准备中的应用价值初探潘鸣赵胜兵²王润东'王树玲'孙洪在'夏天'常欣'顾伦'李兆中

柏愚'SAT肠道准备质量

患者耐受性SATWED3标准化无渣代餐WED3患者自备

低渣饮食THU4肠镜THU4肠镜MON2MON2SUN1SUN1潘鹏，赵胜兵，柏愚.中华消化内镜杂志，2019,36(12):923-927.5FRI5TUETUE肠镜受检者

随机66FRI观察指标试验组(n=32)对照组(n=29)P年龄(岁)51±1350±120.886男性(%)17(53%)12(41%)0.359诊断性结肠镜(%)27(84%)23(79%)0.607饮食限制依从率(%)25(78%)16(55%)0.057肠道准备完成率(%)30(94%)27(93%)0.919进镜时间(分)9.1±2.99.8±3.70.417肠道准备评分7.8±1.07.1±1.30.037肠道准备合格率(%)87.5%79.3%0.388肠镜前饥饿感(%)11(34%)14(48%)0.102不良反应发生率(%)1(3%)1(3%)0.944加强饮食管理，提高肠道准备依从性潘鹏，赵胜兵，柏愚.中华消化内镜杂志，2019,36(12):923-927.饮食限制

第6第124

Ohm

JD

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t

als,

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ru

dr

2019,

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36,

Ml2低渣全营养配方粉在结肠镜肠道准备

中的应用价值初探潘鸱'赵胜兵王润东王树玲孙洪鑫'夏天常欣顾伦李兆申

拍感推荐6:采用标准化的预包装低渣/低纤维饮食有助提高依从性ORIGNALCONTRBUTIOWControlledDietaryRestrictionWith

aPrepackagedLow-Residue

Diet

BeforeColonoscopyOffersBetter-Quality

BowelCleansingandAllowsthe

Use

ofaSmallerVolumeofPurgatives:A

Randomized

MulticenterTrial证据质量：高；推荐强度：弱常用肠道清洁剂的选择和用法理想的肠道清洁剂标准能短时间内排空粪便

>

不引起结肠粘膜改变

>

不引起患者明显不适

>

不导致水电解质紊乱

>

价格适中，依从性好磷酸钠制剂聚乙二醇制剂匹可硫酸钠中草药镁盐制剂甘露醇聚乙二醇制剂安全性好，适用人群广泛，孕妇及婴幼儿的首选用药>

电解质紊乱，晚期肝癌，心衰和肾衰竭患者均可服用最常见不良反应：腹胀，恶心，呕吐；发生率~2.5%常用肠道清洁剂的选择和用法：聚乙二醇PEGOR(95%C0Aoe0.3/20.030,3000

0.909450,206)41450604910120.201185-21cas0ender13160524,3.306)FmukSmokin901,108)Dm07400326,1.67)

0470Como06740247,180)H

13440482,374)H

册1700490,6534hevous

atdomndo

pehe

s1221241.3480303.6002)H

17130703,4176)0.938(0.465,1.891)0.85812常用肠道清洁剂的选择和用法：聚乙二醇PEG◆国内，单中心，前瞻性随机对照研究◆330例肠道准备患者；3Lvs4L

PEGOPEN3-LSplit-dose

isSuperior

to

2-L

Polyethylene

Glycol

in

Bowel

Cleansingin

ChinesePopulationAMulticenterRandomized,ControlledTrialShenghong

Zhang.MD,PhD,Minruf

Li,AMD,Yagang

Zhao,MD,PhD,Tao

Lv,MD,PhD.Qing

Shn,MD,PhD.FachaoZh,MD.PhD,YCun,MD.amdMinhm

Chen,MD.PhD

3L

PEG分次方案不弱于4LPEG方案

hed6d

coonosco(500

yean22523-2521-24LPEG

group1001134352PEGgroupSubgroup100/103123127130136110115405093963202515287938588M常用肠道清洁剂的选择和用法：聚乙二醇PEG3LPEG分次服用方案：结肠镜检查前1天晚上8点服用1L

PEG

结肠镜当天检查前4~6h服用2L

PEG推荐7:3L聚乙二醇的分次剂量方案可提供高质量的肠道情节效果，适合中国人群证据质量：高；推荐强度：强文中高危风险因素：年龄>70岁，便秘，糖尿病，帕金森病，中风或脊柱病史脊髓损伤，既往血压不足史，BMI>25,

以及使用三环类抗抑郁药或麻醉剂常用肠道清洁剂的选择和用法：聚乙二醇PEG推荐8:在肠道准备不充分低风险人群中也可采用2LPEG的单次剂量方案Same-Day

Single

Doseof2

Liter

Polyethylene

Glycol

is

Not

Inferior

to

The

Standard

Bowel

PreparationRegimen

in

Low-Risk

Patients:A

Randomized,

Controlled

TrialXayuKang

MD9,ing

Ztao,MO,Zhong

Zhu,MD,Fe

Laung

WD⁴,Ume

Wang

MD,XangingWng

MD.

Hulun,MD

Lhu

Zhng

MOITac

Dong

MO,Pnongu.MD.Zhangon(Chn,MO.Gu

Ran,MO,Hua.MO.Xaag6in.MOYagnPan.MC,)eanGn,MOandlanmFan,MO证据质量：高；推荐强度：强ORIGNALCONTRBUTIONS口硫酸镁物美价廉，国内很多单位将其作为肠道准备的重要选择口有引起粘膜炎症，溃疡风险及造成粘膜形态改变的可能，因此不

推荐确诊及可以的IBD

患者服用，慢性患者也不宜使用口

用

法：内镜检查前4~6h,

硫酸镁50g加清水100ml

稀释后一次

性服用，同时饮水约2L,

建议大便呈清水样便时，不再饮水常用肠道清洁剂的选择和用法：镁盐推荐9:硫酸镁可作为肠道准备的常用清洁剂但肾功能异常和IBD

患者应避免使用证据质量：低；推荐强度：弱常用肠道清洁剂的选择和用法：磷酸钠WARNINGSThere

havebeanare,butseriousreportsof

acutephospbatenephropathvinpatientswhoreceivedoralsodumphosphateproductsforcoloncleansingpriortocolonoscopy.Somecaseshaveresultedimpermanentimpaimentof

renalfunctionandsomepatientsrequiredlong-term

dialysis

While

some

cases

have

occrred

in

patientswithout

identifable

riskfactors,patientsatincreasedriskof

acutephosphatenephropathymayinclndethosewithincreased

agehypovolemiaincreasedboweltransittime(sich

asbowel

obstnuction)activecolitis,orbaselinekidneydisease,andthoseusingmedicinesthataffectrenalperfiusionorfinction(suchasdiuretics.angiotensinconvertingenzyme

[ACE]inhibitors.angiotensinreceptorblockers

[ARBs].andpossiblynonsteroidalanti-inflammatorydugs

[NSAIDs]SeeWARNINGSItisimportanttousethedoseand

dosing

regimenasrecommended(pm/am

splitdose).

See

DOSAGE

and

ADMLNISTRATION推荐10:不常规使用口服磷酸钠进行肠道准备仅用于有特定需求无法被其他制剂代替，口服前应先评估肾功能年龄小于18岁或大于65岁；活动性炎症性肠病；肠道梗阻慢性肾病、低血容量、电解质紊乱、肝硬化

充血性心竭、心律失常、长期高血压病史服用ACEI、ARB、利尿剂、NSAIDs

者证据质量：高；推荐强度：强Visicol

Tablets(sodiumphosphatemonobasicmonohydrate,USP,and

sodumphosphatedibasic

anhydrous,USP)□以下患者慎用磷酸钠：FDA黑框警告口刺激性泻剂，其活性代谢物质直接作用于结肠粘膜，增加液体分泌，可刺激结肠蠕动口目前匹可硫酸钠在国内尚未上市，相关随机对照研

究较少，国外的高质量研究不多常用肠道清洁剂的选择和用法：匹可硫酸钠mbecmamsP9

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C

aotSplit-dose

bowel

cleansing

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is

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som

s.Saowkand

bettertoleratedthan2-1polyethyleneglycolEur

J

GastroenterolHepatol.2018;30(7):709-717.o声

dPoo4苦t

oon

comn13

s9ma言cound1eg常用肠道清洁剂的选择和用法：甘露醇口不良反应口高渗，易致液体丢失，水电解质紊乱；有利尿和升血糖作用，糖尿病患者禁用口结肠内被细菌酵解后产生爆炸性气体(甲烷和氧气),因此禁用于高频电治疗CASE

REPORTS

FatalColonicExplosionDuringColonoscopicPolypectomyMARC-ANDREBIGARD,PIERREGAUCHER,andCLAU

e

Mal

dAie

dSeAF

ared

Digeatit-Centre

HospitalierUnivetsitairede

Nancy.Nanra

20

colonic

gas

explosion4polypectomyperforations1

deathA

patient

is

described

who

sustoined

the

first

re.

ported

colonic

explosion

during

colonoscopic

pol

ypectomy.Mannitol

solutionwas

usedforhowel

preporotion,andthecolonwascompletelyclean.duringcholetystectomyforsallstones.TheACMIFOR

1-metercnlonoscopewasusedtortheexaminationTheco

lon

proved

to

be

poorly

prepared.The

hepaticfexurepolyp

was

rumoved

by

snare

polypctomy

without

inGastroenterology.1979;77:1307证据质量：低；推荐强度：强推荐12:不建议在治疗结肠镜中使用甘露醇进行肠道清洁Figure1

Flowchartof

published

caseswih

colonic

gas

explosionWorldJ

Gastroenterol.2007;13.5295-8.perforations2

perforatisur

rgeryAPC44番泻叶口某些医院仍在使用，但不建议单多作肠道准备用

口不良反应：腹痛腹胀较常见，可致粘膜炎症改变口用法：检查前晚番泻叶20g加400ml

(原叶20倍质

量)开水浸泡30min

或80℃水温浸泡1h服用常用肠道清洁剂的选择和用法：中草药推荐13:中草药制剂应与其他肠道清洁剂联合使用以减少不良反应证据质量：低；推荐强度：弱结肠镜检查前的辅助措施：祛泡剂口结肠镜检查时，肠道泡沫的发生率约30-40%

口大量泡沫会影响对结肠粘膜及病灶的观察口国内六中心，随机，对照研究□

600例结肠镜前肠道准备患者□

2LPEG+西甲硅油vs.2LPEG祛泡剂组肠道准备更佳，腺癌检出率更高结肠镜检查前的辅助措施：祛泡剂Impact

of

preproceduresimethicone

on

adenoma

detectionrate

during

colonoscopy:a

multicenter,endoscopist-blinded

randomized

controlled

trialOriglnal

articlePEG+

西甲硅油

PEG肠道准备质量肠道息肉检出率祛泡剂dok:10.11METAANALYSISAND

SYSTEMATICREVIEWEffect

of

supplemental

simethicone

for

bowel

preparation

onadenoma

detection

during

colonoscopy:A

meta-analysis

ofrandomized

controlled

trialsPengPan·ShengBingZhao'BngHanuOan-OanMeng.'JunYao'Dong

Wanghao

Shenu*and

Yu

faSimethicone

Use

During

Gastrointestinal

Endoscopy:Position

Statement

of

theGastroenterologicalSocietyofAustraliaBenedictMDevereauxMB.BS².AndrewCFTaylorMD²,EugeneAthanMD',DavidJWallis

BN²,Robyn

R

Brown

RN',Sue

M

Greig

MN⁴,Fiona

K

Bailey

MPH²,Karen

Vickery

PhD,EliabethWardleRN⁵,DianneMJonesBAppse口用法推荐：西甲硅油30ml,可与最后一次泻药同时服用，或者在泻药服用后30~60min

内服用推荐14:在肠道准备过程中建议常规应用祛泡剂Impact

of

preprocedure

simethicone

on

adenoma

detection

rate

during

colonoscopy:a

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randomized

controlled

trialAuh

hatenF,ajtWinwh,

gzh

.Dpng

Wang'Ye

Qingw.

ho

sh,0-0ineo-0nno证据质量：高；推荐强度：强Gatroenterolorr

ind

Hepato·慢性便秘，未严格按照要求进行肠道准备(术前高纤维饮食，PEG

引用不足),肥胖，高龄，既往结肠外科手术史，伴有其他疾病(如糖尿病，帕金森等),服用抗抑郁药等肠道准备不佳高危患者Dipostive

DiseishurnutetDgeureDoaw20te

17:4463

dot

101111/1751-2980.12376OriginalarticleConstipation,fiber

intakeand

non-compliancecontributetoinadequatecolonoscopybowelpreparation:a

prospectivecohort

study危险因素

i

t

i

i

a

hMQe-l

lonoscopy

@KunjatGandh.ChristinaTofani,"CarlySokach,'DovinPatet'DavidKastenberg.andConstantineDaskalakisnalysisy

ofCoaitaatuticReview

andAssociatedWitmcsstestSyer:Aacnrparatioent

ChaPrePatPredictorsofSuboptimalBowelPreparationUsing3-1

fP

loys

t

c

eO

ioornanl

S

u

atient

Colonoscopy:KRiskfactorsforinadequatebowelpreparation:

avalidatedpredictivescorehunTANG,*longVu.yunAIoROISAL

AWmc,6CinlcatGastoentarlouandhopatology2010,16.397-309WANGChn

Sog4nm

og肠道准备不佳高危风险患者推荐15:对于纯在肠道准备不充分危险因素的患者可在应用标准肠道准备方案的同时采取额外准备措施0ptimizing

Adequacy

of

Bowel

Cleansing

for

Colonoscopy:

Recommendations

From

the

US

Multi-Society

Task

Force

on

Colorectal

CancerDavidA.Johnson,'AlanN.Barkun,LaryB.Cohen,JasonA.Dominitz,'TonyaKaltenbach,

Myriam

Martel,Douglas

J.Robertson.C.Richard

Boland,"Frances

M.Giardello,DavidA.Leberman,Theodore

R

Levin,"andDouglas

K.Rex"可选辅助措施：4L

PEG方案，术前3天低渣饮食，使用促胃肠动力药物等证据质量：高；推荐强度：强Comparison

ofTwo

Intensive

Bowel

Cleansing

Regimens

in

PatientsWith

Previous

Poor

BowelPreparation:ARandomizedControlledStudyORIGINALCONTRIBUTIONSAGA

SECTIONGastoentemlogy2014147903-924肠道准备不充分患者推荐16:若内镜检查过程中发现患者肠道准备不充分。应积极评估，并采取补救措施或改期行内镜检查A

Randomized

ControlledTrial

Comparing

ColonoscopicEnema

With

AdditionalOralPreparationasaSalvageforInadequate

BowelCleansingBeforeColonoscopySoo-Kr

-

kn

h

S

mmg

e

MD+YamhoJngMD

PhDfChang

Soo

Emm

MD

PhDfandDong

Soo

Han

MD.PhDSc*LDachoMDTkAI/ng*DuP*DDMMDYamPaJoungHro证据质量：高；推荐强度：强Colonoscopic

enema

as

rescue

for

inadequate

bowelpreparationbeforecolonoscopy:a

prospective,observational

studyA.Horluchi,Y.Nalayama't,M.Kajyama*,N.Kato*,T.Kamljima*,Y.Ichhe⁴andN.Tanaka4补救措施：2L

PEG口服Hassteun2012cgst27Mea2Aundat

oa0orjpulartded×101m/1+63-0201203107ORIGINAL

ARTICLE患有或疑似炎症性肠病者JoumalafCohe

s

ndCoits2014,1-10doi101030/ecco

jc[s040

Advince

Acess

pabicatoo

Febrary13.201906ginalArnceOriginalArticleEfficacy,Tolerability,andSafety

ofLow-Volume

Bowel

Preparations

forPatients

with

Inflammatory

Bowel

Diseases:

The

French

Multicentre

CLEAN

Study推荐17:对患有或疑似IBD患者，避免使用磷酸盐类清洁剂尽量使用小剂量聚乙二醇方案World

JournalofGastroenterologysopt

hop//wwwpaboshingzom

WuCwn07ApBu9%40nDoE

10745/mgev2354

S6N10079027punn

ISSN2219240

onlane证据质量：中等；推荐强度：弱WLU1oUWICSystematic

reviewandmeta-analysisofcoloncleansing

preparations

in

patientswith

inflammatory

boweldisease小剂量方案：2LPEG下消化道出血患者Cinical

Gastoenterology

and

kepatobogy2016,14558-564Safetyand

EffectivenessofEarlyColonoscopy

in

Manag