Detection rates of premalignant polyps during screening colonoscopy: Time to revise quality standards?
Detection rates of premalignant polyps during screening colonoscopy: Time to revise quality standards?
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DOI：
10.1016/j.gie.2014.07.030
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发表时间：
2015-03-01
影响因子：
7.7
通讯作者：
Raju, Gottumukkala S.
中科院分区：
文献类型：
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作者：
Ross, William A.;Thirumurthi, Selvi;Raju, Gottumukkala S.
背景：筛查结肠镜检查过程中腺瘤的检测标准被广泛用于衡量检查质量。无蒂锯齿状腺瘤 (SSA) 不存在这样的标准。目的：在质量改进/经济激励措施之前和之后的结肠镜筛查期间测量腺瘤检出率 (ADR) 和 SSA 检出率 (SSADR)。设计：由内窥镜医师回顾性确定基线 ADR/SSADR，然后在告知医生基线后前瞻性收集数据 地点：拥有大型癌症筛查计划的三级癌症中心。患者：总共 2833 名 50 至 75 岁的平均风险结直肠癌筛查患者，接受初次结肠镜检查。数据收集：适应症和人口统计数据、内窥镜报告和病理报告的电子病历。主要结果测量：按性别划分的腺瘤和 SSA 检出率。结果：男性和女性患者的总体 ADR 分别为50.6%和36.6%。男性和女性患者晚期腺瘤的总体检出率分别为12.4%和6.5%。男性和女性患者的总体 SSADR 分别为 10.1% 和 7.1%。在 108 名患者（占整个组的 3.8%）中，SSA 是唯一发现的癌前病变。随着时间的推移，两种类型的癌前息肉的检出率均有所提高，但未达到统计学显着性。局限性：单中心经验、样本量有限且内镜医师群体较小。结论：ADR 远远超过当前标准是可以实现的。盲肠戒断时间与 ADR 相关。 SSA 的患病率与晚期腺瘤的患病率相当，并且比当前医学文献显示的要高。监测和财政激励措施的结合并没有导致 ADR 在统计上显着改善。
Background: Standards for the detection of adenomas during screening colonoscopy are widely used to measure examination quality. No such standards exist for sessile serrated adenomas (SSAs).Objective: To measure both the adenoma detection rate (ADR) and SSA detection rate (SSADR) during screening colonoscopy before and after quality improvement/financial incentive measures.Design: Retrospective determination of baseline ADR/SSADR by the endoscopist, followed by prospective collection of data after informing physicians of baseline detection rates.Setting: Tertiary cancer center with a large cancer screening program.Patients: A total of 2833 average-risk colorectal cancer screening patients 50 to 75 years of age undergoing initial colonoscopy.Data Collection: Electronic medical records for indication and demographics, endoscopy report, and pathology report.Main Outcome Measurements: Detection rates of adenomas and SSAs by sex.Results: The overall ADR in male and female patients was 50.6% and 36.6%, respectively. The overall detection rate of advanced adenomas in male and female patients was 12.4% and 6.5%, respectively. The overall SSADR in male and female patients was 10.1% and 7.1%, respectively. In 108 patients (3.8% of entire group), SSAs were the only premalignant lesions found. Detection rates of both types of premalignant polyps improved over time but did not reach statistical significance.Limitations: Single-center experience with limited sample size and small group of endoscopists.Conclusion: ADRs far in excess of current standards are achievable. Cecal withdrawal time is associated with the ADR. Prevalence of SSA rivals that of advanced adenomas and is greater than current medical literature suggests. The combination of monitoring and financial incentives did not result in statistically significant improvement in ADRs.