Fewer Polyps Detected by Colonoscopy as the Day Progresses at a Veteran's Administration Teaching Hospital
Fewer Polyps Detected by Colonoscopy as the Day Progresses at a Veteran's Administration Teaching Hospital
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DOI：
10.1016/j.cgh.2009.07.013
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发表时间：
2009-11-01
影响因子：
12.6
通讯作者：
Spiegel, Brennan M. R.
中科院分区：
文献类型：
--
作者：
Chan, Michael Y.;Cohen, Hartley;Spiegel, Brennan M. R.
背景与目的：结肠镜检查的目的之一是识别和切除息肉--这一过程需要注意细节和长时间的专注。提供者容易出现认知错误，因为这一过程经常在一天中重复进行。我们测量了结肠镜检查开始时间和息肉产量之间的调整关系。方法：我们对477名在退伍军人管理局(VA)入院接受筛查、监测或诊断性结肠镜检查的患者进行了前瞻性研究。主要的结果衡量标准是息肉产量。我们收集了结肠镜检查开始时间的数据，并将其分析为两个时间段(清晨病例与较晚病例)和连续变量(开始时间)。我们使用单变量分析确定显著的危险因素，并进行泊松多变量回归来衡量结肠镜检查开始时间对息肉产量的独立影响。我们评估了在预先指定的时间间隔内，随着一天的进展，息肉产量减少的证据。结果：在单变量分析中，清晨患者的息肉发生率比晚患者高27%(95%可信区间，11%-45%；P<；.001)。随着时间的推移，息肉、增生性息肉和腺瘤性息肉的总数逐小时减少。多变量分析表明，清晨患者的息肉发生率比晚患者多20%(95%可信区间，5%-38%；P=0.007)。结论：在退伍军人医学中心，清晨接受结肠镜检查的患者与当天晚些时候相比，发现更多的息肉。此外，随着时间的推移，腺瘤的检测率也在下降。提供者可能最擅长在一天开始的时候检测息肉；需要在其他实践环境中进一步验证。
BACKGROUND & AIMS: One objective of colonoscopy is to identify and remove polyps-this process requires attention to detail and prolonged concentration. Providers are predisposed to cognitive errors because the procedure is often performed repetitively throughout the day. We measured the adjusted relationship between colonoscopy start time and polyp yield. METHODS: We performed a prospective Study of 477 patients that received screening, Surveillance, or diagnostic colonoscopies at a Veteran's Administration (VA) reaching hospital. The primary outcome measure was polyp yield. We collected data on colonoscopy start times, which were analyzed both as a dichotomous time period ("early-morning case" vs "later case") and as a continuous variable (start time). We identified significant risk factors using univariate analysis and performed Poisson multivariable regression to measure the independent effect of colonoscopy start time on polyp yield. We evaluated evidence of decreasing polyp yield as the day progressed throughout pre-specified time intervals. RESULTS: In univariate analysis, early-morning cases yielded 27% more polyps per patient than later cases (95% confidence interval, 11%-45%; P < .001). The total numbers of, hyperplastic and adenomatous polyps found decreased hour-by-hour as the day progressed. Multivariable analysis demonstrated that early-morning cases yielded 20% more polyps per patient than later cases (95% confidence interval, 5%-38%; P = .007). CONCLUSIONS: At a VA medical center, more polyps were detected in patients that received colonoscopies early in the morning compared with later in the day. Moreover, adenoma detection reduced as the day progressed. Providers might be most adept at detecting polyps at the beginning of the day; further validation in other practice settings is required.