Differences in Detection Rates of Adenomas and Serrated Polyps in Screening Versus Surveillance Colonoscopies, Based on the New Hampshire Colonoscopy Registry
Differences in Detection Rates of Adenomas and Serrated Polyps in Screening Versus Surveillance Colonoscopies, Based on the New Hampshire Colonoscopy Registry
复制标题
DOI：
10.1016/j.cgh.2013.04.042
复制
发表时间：
2013-10-01
影响因子：
12.6
通讯作者：
Weiss, Julia E.
中科院分区：
文献类型：
--
作者：
Anderson, Joseph C.;Butterly, Lynn F.;Weiss, Julia E.
背景与目的：腺瘤检出率（ADR）是最初发展起来用于结肠镜筛查的一项重要质量指标。然而，尚不清楚是否应该使用筛选和监测检查的数据来计算不良反应。筛查检查的推荐基准ADR为20%（女性为15%，男性为25%）。很少有数据可以比较监测和筛查结肠镜检查的不良反应。我们使用基于人群的登记来比较筛查结肠镜和监测结肠镜的不良反应。研究了一种潜在的新型质量指标——锯齿状息肉的检出率（SDR）。方法：通过使用新罕布什尔结肠镜登记的数据，我们排除了不完全结肠镜检查和诊断性结肠镜检查，以及那些在炎症性肠病、家族性综合征或肠道准备不良的患者中进行的结肠镜检查。我们计算了9100例结肠镜检查中ADR和SDR（分别检测到至少1个腺瘤或锯齿状息肉的结肠镜检查次数除以结肠镜检查次数）。通过结肠镜检查指征（筛查、监测）、结肠镜检查年龄（50-64岁，>= 65岁）和性别对ADR和SDR进行比较。结果：监测结肠镜不良反应发生率（37%）显著高于筛查结肠镜（25%,P < 0.001）。这种差异在性别和年龄组中都有观察到。筛查的SDR（8%）与监测结肠镜检查的SDR （10%; P < 0.001）差异较小。结论：在一项基于人群的研究中，我们发现来自监测结肠镜检查的数据增加了ADR，但对SDR的影响较小。这些发现表明，当将不良反应作为一项质量指标来计算时，内窥镜医师应该使用筛查而不是监测结肠镜数据。
BACKGROUND & AIMS: The adenoma detection rate (ADR) is an important quality indicator originally developed for screening colonoscopies. However, it is unclear whether the ADR should be calculated using data from screening and surveillance examinations. The recommended benchmark ADR for screening examinations is 20% (15% for women and 25% for men >= 50 y). There are few data available to compare ADRs from surveillance vs screening colonoscopies. We used a population-based registry to compare ADRs from screening vs surveillance colonoscopies. The serrated polyp detection rate (SDR), a potential new quality indicator, also was examined.METHODS: By using data from the statewide New Hampshire Colonoscopy Registry, we excluded incomplete and diagnostic colonoscopies, and those performed in patients with inflammatory bowel disease, familial syndromes, or poor bowel preparation. We calculated the ADR and SDR (number of colonoscopies with at least 1 adenoma or serrated polyp detected, respectively, divided by the number of colonoscopies) from 9100 colonoscopies. The ADR and SDR were compared by colonoscopy indication (screening, surveillance), age at colonoscopy (50-64 y, >= 65 y), and sex.RESULTS: The ADR was significantly higher in surveillance colonoscopies (37%) than screening colonoscopies (25%; P < .001). This difference was observed for both sexes and age groups. There was a smaller difference in the SDR of screening (8%) vs surveillance colonoscopies (10%; P < .001).CONCLUSIONS: In a population-based study, we found that addition of data from surveillance colonoscopies increased the ADR but had a smaller effect on the SDR. These findings indicate that when calculating ADR as a quality measure, endoscopists should use screening, rather than surveillance colonoscopy, data.