Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Effectiveness of Walking-exercise on Bowel Preparation for Colonoscopy

대장내시경 전처치에 미치는 걷기 운동의 효과

Park, Dong-Hun;Kim, Hyun-Soo;Kim, Moon-Young;Choi, Yoon-Jong;Seo, Jung-In;Jung, Phil-Ho;Baik, Soon-Koo;Lee, Dong-Ki;Kwon, Sang-Ok
박동훈;김현수;김문영;최종윤;서정인;정필호;백순구;이동기;권상옥

  • Published : 20020000
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Abstract

Background/Aims: This prospective study was conducted to assess the effect of walking-exercise on the bowel cleansing before colonoscopy and to define subgroup of patients to whom walking-exercise was beneficial. Methods: Before taking 2.5 L of polyethylene glycol, 393 out-patients were randomized into two groups (G1; walking-exercise, G2; non-exercise) and the amount of walking-exercise was estimated by the step counter. A single colonoscopist performed the procedure with a single-blinded manner and estimated the bowel cleansing. Results: A total of 366 patients were included by per protocol analysis. The number of step count was significantly different between two groups (p＜0.000). However, the groups were similar in other data collected. The degree of bowel cleansing between two groups was significantly different (p＜0.01). Age, history of abdominal surgery, constipation, obesity and walkingexercise were related to the degree of bowel cleansing. Interestingly, walking-exercise was especially beneficial to patients with age less than 65 years, without history of abdominal surgery, and non-obesity. Multivariate analysis demonstrated that absence of constipation (OR=4.74), walkingexercise (OR=2.04), and younger age (OR=1.97) were independent factors associated with better bowel cleansing. Most of walking patients (97.4%) answered that walking-exercise is more comfortable than taking the solution. Conclusions: The walking-exercise was of an additional benefit to improve colonoscopic bowel cleansing without significant patients discomfort.

목적: 본 연구는 대장내시경 검사 전 걷기 운동이 대장 청결도를 개선시키는지와 걷기 운동이 전처치에 도움이 되는 환자의 특성을 알아보고자 하였다. 대상 및 방법: 2000년 12월부터 2001년 10월까지 본원에서 시행한2112명의 대장내시경 검사 중 외래로 내원하고 연구에 동의한 393명을 대상으로 하였다. 검사 당일 모든 환자에게 만보계를 착용시킨 후 운동군과 비운동군으로 무작위 배정하여 운동군에서는 $Colonlyte^(R)$ 복용과 동시에 계속 걷도록 지시하였으며 검사 직전 두 군에서 만보계의 횟수를 측정하였다. 대장내시경은 숙련된 내시경 전문의 한 명이 시행하여 대장의 청결도를 4단계 (excellent, good, fair, poor)로 구분하였고 운동군에서는 검사 후$Colonlyte^(R)$ 복용과 비교하여 걷기 운동의 불편도를 3단계로 일중맹검법으로 조사하였다. 프로토콜분석이 가능했던 366명(93.1%)을 대상으로 검사 전 환자의 연령, 성별, 비만도, 변비유무, 복부 수술력, 산부인과 수술력, 대장 내시경의 과거력, 만성 질환의 동반 유무를 조사하였고, 전처치액 복용 후 검사 전 소요시간을 측정하였다. 결과: 대상군의 평균연령은 52세(16-84세)이었고, 남자 185명, 여자 181명이었다. 운동군(n=189)과 비운동군(n=177) 간의 연령, 성별, 비만도, 변비 유무, 복부 수술력, 산부인과 수술력, 대장 내시경의 과거력, 만성 질환의 동반 유무는 차이가 없었다. 대장의 청결도는 운동군에서 excellent, good, fair, poor군이 각각 4 (2.1%), 7. (38.6%), 108 (57.1%), 4 (2.1%)명이었고, 비운동군에서는 5 (2.8%), 40 (22.6%), 125 (70.6%), 7 (4.0%)명으로 두 군 간에 유의한 차이를 보였다(p=0.004). 단일 변량 분석에서 연령(p=0.015), 복부 수술력(p=0.017), 비만 여부(p=0.033), 변비유무(p=0.006), 걷기 운동 여부(p=0.010)가 대장 청결도와 관련이 있었다. 그러나 65세 이상이거나 복부 수술의 과거력이 있는 경우, 그리고 비만군에서는 걷기 운동이 대장 청결도에 영향을 미치지 못하였다. 다변량 로지스틱 회계분석에서 대장 청결도는 연령(p=0.044), 변비 유무(p=0.002), 걷기 운동 여부(p=0.003)와 관련이 있었다. 또한 운동군에서 97.4%의 대다수 환자는 걷기 운동이$Colonlyte^(R)$복용에 비하여 덜 불편한 것으로 답하였다. 결론: 대장 내시경의 전처치 과정에서 걷기 운동을 병행하는 것은 큰 불편 없이 대장 청결도를 개선할 수 있는 효과적인 방법이라고 생각한다.

Keywords

References

  1. Kim WH, Cho YJ, Park JY, Min PK, Kang JK, Park IS. Factors affecting insertion time and patient discomfort during colonoscopy. Gastrointest Endosc 2000;52:600-605 https://doi.org/10.1067/mge.2000.109802
  2. Hsu CW, Imperiale TF. Meta-analysis and cost comparison of polyethylene glycol lavage versus sodium phosphate for colonoscopy preparation. Gastrointest Endosc 1998;48:276-282 https://doi.org/10.1016/S0016-5107(98)70191-9
  3. Sharma VK, Chockalingham SK, Ugheoke EA, et al. Prospective, randomized, controlled comparison of the use of polyethylene glycol electrolyte lavage solution in four-liter versus two-liter volumes and retreatment with either magnesium citrate or bisacodyl for colonoscopy preparation. Gastrointest Endosc 1998;47:167-171 https://doi.org/10.1016/S0016-5107(98)70351-7
  4. Adams WJ, Meagher AP, Lubowski DZ, King DW. Bisacodyl reduces the volume of polyethylene glycol solution required for bowel preparation. Dis Colon Rectum 1994;37:229-233 https://doi.org/10.1007/BF02048160
  5. Ziegengagen DJ, Zhnter E, Tacke W, Gheorghiu T, Krvis W. Senna vs bisacodyl in addition to Golytely lavage for colonoscopy preparation-a prospective randomized trial. Z Gastroenterol 1992;30:17-19
  6. Lazzaroni M, Petrillo M, Desideri S, Bianchi PG. Efficacy and tolerability of polyethylene glycol-electrolyte lavage solution with and without simethicone in the preparation of patients with inflammatory bowel disease for colonoscopy. Aliment Pharmacol Ther 1993;7:655-659 https://doi.org/10.1111/j.1365-2036.1993.tb00148.x
  7. Brady CE 3rd, DiPalma JA, Pierson WP. Golytely lavage: is metoclopramide necessary? Am J Gastroenterol 1985;80:180- 184
  8. James M. Church. Effectiveness of polyethylene glycol antegrade gut lavage bowel preparation for colonoscopy-timing is the key! Dis Colon Rectum 1998;41:1223-1225
  9. Kottapalli V, Wright R. Effectiveness of polyethylene glycol antegrade gut lavage bowel preparation for colonoscopy-timing is the key? Gastrointest Endosc 1999;50:726-727
  10. Dapoigny M, Sarna SK. Effects of physical exercise on colonic motor activity. Am J Physiol 1991;260:G646-G652
  11. Rao SS, Beaty J, Chamberlain M, Lambert PG, Gisolf C. Effects of acute graded exercise on human colonic motility. Am J Physiol 1999;276:G1221-G1226
  12. Chilton AP, O'Sullivan M, Cox MA, Loft DE, Nwokolo CU. A blinded, randomized comparison of a novel, low-dose, triple regimen with fleet phospho-soda: a study of colon cleanliness, speed and success of colonoscopy. Endoscopy 2000;32:37-41. https://doi.org/10.1055/s-2000-133
  13. Church JM. Complete colonoscopy: How often? and if not, why not? Am J Gastroenterol 1994;89:556-560
  14. Cirocco WC, Rusin LC. Factors that predict incomplete colonoscopy. Dis Colon Rectum 1995;38:964-968 https://doi.org/10.1007/BF02049733
  15. Reid M. Ness, Raj Manam, Helena Hoen, Naga Chalasani. Predictors of inadequate bowel preparation for colonoscopy. Am J Gastroenterol 2001;96:1797-1802 https://doi.org/10.1111/j.1572-0241.2001.03874.x
  16. Cynthia Taylor, Mitchell L. Schubert. Decreased efficacy of polyethylene glycol lavage solution (Golytely) in the preparation of diabetic patients for outpatient colonoscopy: a prospective and blinded study. Am J Gastroenterol 2001;96: 710-714 https://doi.org/10.1111/j.1572-0241.2001.03610.x