Adenoma detection rate: The real indicator of quality in colonoscopy
Adenoma detection rate: The real indicator of quality in colonoscopy
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DOI：
10.1007/s10350-008-9315-3
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发表时间：
2008-08-01
影响因子：
3.9
通讯作者：
Church, James M.
中科院分区：
文献类型：
--
作者：
Millan, Monica S.;Gross, Perita;Church, James M.
目得：完成率是结肠镜检查中最常用的质量指标，但完整的检查不一定是好的检查。检测和治疗腺瘤的能力是内窥镜技术的重要组成部分，因为许多结肠镜检查都是为了这一明确目的而进行的。腺瘤检出率很少报道，尽管它似乎取决于停药所需的时间。文献表明，腺瘤应在大约25%的男性和15%的女性年龄超过50岁。我们回顾了六位结直肠外科医生的腺瘤检出率，以深入了解腺瘤检出率的范围和影响因素。记录结肠镜检查完成率、腺瘤检出率、插入和撤出时间，并由6名结肠镜检查员进行分层。腺瘤检出率按结肠镜检查的四种常见适应症列表。结果：每位内镜医师每年进行> 250次检查，总计进行> 1,000次检查。虽然完成率相当一致（平均96.5%（范围94.8- 97.9%）），但ADR的范围很广，特别是当腺瘤很常见时（息肉或癌症监测;范围14.2- 27.4%）。排除一名异常工作人员后，退出时间对腺瘤检出率的回归分析得出r（2）为0.975（P = 0.0016）。结论：腺瘤检出率作为结肠镜检查质量指标独立于完成率。在经验丰富的结直肠外科医生中，腺瘤的检出率有很大的差异。结肠镜检查者需要了解他们的腺瘤检出率。
PURPOSE: Completion rate is the most commonly used index of quality in colonoscopy, and yet a complete examination is not necessarily a good examination. The ability to detect and treat adenomas is an important component of endoscopic skill, because many colonoscopies are performed for this express purpose. Adenoma detection rate is rarely reported, although it seems to depend on the time taken for withdrawal. The literature suggests that adenomas should be detected in approximately 25 percent of men and 15 percent of women older than age 50 years. We have reviewed the adenoma detection rates of six colorectal surgeons to provide insight into the range of adenoma detection rates and the factors that influence them.METHODS: A prospective departmental colonoscopy database was queried. Colonoscopy completion rates, adenoma detection rates, and times of insertion and withdrawal were noted and stratified by the six staff colonoscopists. Adenoma detection rates were tabulated for the four common indications for colonoscopy.RESULTS: Each staff endoscopist performed > 250 examinations per year and had performed > 1,000 total examinations. Although completion rates are fairly uniform (mean, 96.5 (range, 94.8-97.9) percent), there is a wide range of ADR, especially when adenomas are common (polyp or cancer surveillance; range, 14.2-27.4 percent). With the exclusion of one outlier staff, regression of withdrawal time against adenoma detection rate produced an r(2) of 0.975 (P = 0.0016).CONCLUSIONS: Adenoma detection rate is independent of completion rate as a colonoscopy quality indicator. There is a wide range of adenoma detection rates among experienced colorectal surgeons. Colonoscopists need to be aware of their adenoma detection rate.