大腸鏡檢前採用低渣飲食是否能改善腸道清潔度Can the low residue diet improve the bowel Preparation before the implementation of colonoscopy?

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2019-05-06 已刊登
新刊登 綜 整 預防/治療/介入類型

作  者

蔡慧于*

實證知識類別

A 類:實證健康照護綜整

PICO

治療/預防性問題

治療/介入措施

胃腸肝臟系統 Gastroenterology and Hepatology

科別

  • 臨床指引/實證照護成效 Clinical Guidelines/Evidence Based Outcomes

中文關鍵詞

大腸鏡、低渣飲食、腸道清潔、腸道準備

英文關鍵詞

Colonoscopy、low residue diet、bowel clean、bowel prepare

機構名稱

長庚醫療財團法人高雄長庚紀念醫院

申請單位

護理部

中文摘要

形成臨床提問:
由於國人飲食習慣的改變,國內大腸癌或大腸瘜肉發生率增加且年齡層下降,大腸鏡檢查為早期發現瘜肉或癌變最有利的篩檢工具。大腸鏡檢前需要配合清潔腸道,以利執行檢查、提高腺瘤檢出率並降低執行過程中的風險。腸道清潔除了需要以配合清腸瀉劑使用外,亦需病人配合飲食上腸道準備,傳統的清流飲食在執行中容易讓病人產生飢餓感、頭暈或低血糖等,近年研究顯示在腸道準備中,使用低渣飲食與清流質飲食相較下,清腸結果並無顯著差異,然而低渣飲食對於病人會有更佳的滿意及耐受度,故採實證方式探討低渣飲食之臨床應用參考。
文獻搜尋的方法與分析:
本文以實證手法依關鍵字以MeSH term、布林邏輯、切截字以及限定欄位等方式,搜尋Cochrane、PubMed、Embase、CINAHL、華藝及碩博士論文系統資料庫,找出符合PICO的文章來進行評讀,篩選後選擇SR及RCT文章各一篇,使用CASP為工具以進行嚴格評讀,評讀內容主要三大面向即VIP:V(Validity/Reliability)效度/信度、I(Importance/Impact)重要性,以及P(Practice/Applicability)臨床適用性。
文獻的品質評讀:
評析PICO問題為治療型,依據Oxford CEBM建議等級,此二篇文章分別為systemic review以及RCT,文獻證據等級為Level 1及Level 2。分析結果:CLD組及LRD組在腸道準備上結果上無統計顯著差異。在病人滿意度及耐受性來說,低渣飲食組比清流質飲食組較高,對於花費及傷害等無明顯差異,且評讀的兩篇文獻結果皆呈現一致性,以GRADE評分系統證據品質,評析證據品質分級為「高」、建議強度分級為「強」。
結論與建議:
大腸鏡檢查是早期診斷大腸瘜肉或大腸癌篩檢的最佳工具。大腸鏡檢查的成功取決於許多因素,其中主要則是腸道準備的品質。依據文獻建議,大腸鏡檢前確實衛教採用低渣飲食較只採清流質飲食來說能增加飽足感,可增加的病人在準備過程中的遵從性、滿意度以及再次重覆準備的意願,建議將大腸鏡檢前的清流質飲食改成低渣飲食並採用標準化執行。

英文摘要

Ask an answerable question (PICO):
The diet habit for the people in Taiwan has been changed, so the possibility to suffer colon cancer and colon polyposis has increased, and the age of the people to suffer them has also decreased. The colonoscopy is the optimal tool to be applied to discover and screen the polyp and cancer early. Before the implementation of colonoscopy, the bowel preparation trace needs to be done first, to increase the rate that adenoma being detected and minimize all the possible risk during the examination. The bowel preparation needs to be done along with cathartics, and it may require the patient to be dietary restriction. The patient who has the traditional clean liquid diet will easily feel hungry, dizzy, and being hypoglycemic. The recent research indicates that the patient uses the clean liquid diet and the low residue diet does not show the apparent evidence to the result of bowel preparation. However, the patient has a low residue diet seemed to have higher satisfaction and tolerance. Therefore the evidence-based method is applied and to discuss the low residue diet in clinical.
The Method and Analysis of Literature Review:
The study is based on the evidence-based and follow the sequence of keywords of Mesh term, Boolean logic, Truncation, Limited column, to search Cochrane, PubMed, Embase, CINAHL, Airiti Library and National Digital Library of theses and dissertations in Taiwan. We try to find the article which is in line with PICO and selected two articles to critical appraisal, included with three broad heading VIP: V(Validity/Reliability), I (Importance/Impact), P(Practice/Applicability).
Critical Appraisal:
It is a therapeutic type to criticize and analysis PICO’s question. According to the suggested grade at Oxford CEBM, two of the studies are level 1 and level 2. The result of the analysis: for the subject of bowel preparation , there is no significant difference between the CLD team and the LRD team (the quality of index of proceeding the colonoscopy: BBPS、Aronchick scale or Ottawa scale. For the issue of a patient's satisfaction and tolerance, the low residue diet has a higher score than the clean liquid diet. As to the expenditure and harm, it is no noticeable difference. The result of the critical appraisal skill of quality to two of the bibliography indicates consistency. The assessment system of GRADE to justify the quality, the evidence of analysis is categorized as “high,” the suggestion strength is classified as “strong.”
Conclusions and Recommendations:
The colonoscopy is the best tool for early diagnosis and screen colon polyp and colon cancer. There are quite a few factors to achieve the success of inspection of colonoscopy. The primary factor is the quality of bowel preparation. According to the suggestion indicated in the bibliography, to practice a hygiene education to adopt the low residue diet does help to enhance the full feeling and it increases the patient ‘s willingness to operability, satisfaction and repeating preparation during the preparation before the implementation of colonoscopy than to adopt a clean liquid diet. The suggestion is to replace the clean liquid diet by the low residues diet before the implementation of colonoscopy and also standardize the procedure.