Judgement of the quality of bowel preparation at screening flexible sigmoidoscopy is associated with variability in adenoma detection rates
Judgement of the quality of bowel preparation at screening flexible sigmoidoscopy is associated with variability in adenoma detection rates
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DOI：
10.1055/s-2006-925259
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发表时间：
2006-05-01
期刊：
影响因子：
9.3
通讯作者：
Atkin, W.
中科院分区：
文献类型：
--
作者：
Thomas-Gibson, S.;Rogers, P.;Atkin, W.
背景和研究目的：已知内镜医师之间在乙状结肠镜检查中腺瘤检出率（ADR）存在差异。所使用的技术和肠道准备质量的差异可以解释这一点。本研究的目的是建立是否有分级肠道准备和ADR.Materials和方法之间的关系：ADR和评估肠道准备之间的关系进行了研究，使用完整的英国乙状结肠镜检查筛选试验数据集（n = 38 601）。肠道准备分类的一致性，然后由6位经验丰富的内窥镜（视频评分），谁检查260个灵活的乙状结肠镜检查的情况下，20从每个13个试验endoscopists.Results的一致性进行了调查：总体而言，ADR是显着较高的灵活乙状结肠镜检查与优秀或良好的肠道准备（P = 0.02）。然而，ADR较高的内镜医师将其检查编码为极好/良好准备的比例较小（P = 0.002）。在48.9%的读数中，视频评分员同意试验内窥镜医生对肠道准备的定义，但他们对准备质量的评分分别为36.4%和40.6%，在中等绩效组中，不良反应发生率（10% < ADR < 14%）和不良反应发生率（ADR < 10%）高于高效能组（ADR > 14%）的12.9%。有一个显着的线性趋势之间的比例得分为不良肠道准备和ADR（P < 0.001），从2.7%的高性能ADR组的13.4%的低性能group.Conclusions：内镜医生与ADR较高的肠道准备的质量更可能是关键。为了确保筛查程序的普遍高标准，需要对判断过程进行培训，例如不接受次优肠道准备。
Background and Study Aims: Adenoma detection rates (ADRs) at screening flexible sigmoidoscopy are known to vary between endoscopists. Variability in the technique used and in the quality of bowel preparation may explain this. The aim of this study was to establish whether there is a relationship between the grading of bowel preparation and the ADR.Materials and Methods: The relationship between the ADR and assessment of bowel preparation was examined using the full United Kingdom Flexible Sigmoidoscopy Screening Trial data set (n = 38 601). The consistency of the bowel preparation classification was then investigated by six experienced endoscopists (video scorers), who examined 260 flexible sigmoidoscopy cases 20 from each of the 13 trial endoscopists.Results: Overall, the ADR was significantly higher in flexible sigmoidoscopy examinations with excellent or good bowel preparation (P = 0.02). However, endoscopists with a higher ADR coded a smaller proportion of their examinations as having excellent/good preparation (P = 0.002). Video scorers agreed with the trial endoscopists' definition of bowel preparation in 48.9% of the readings, but they scored the quality of preparation as poorer than the trial endoscopists in 36.4% and 40.6%, respectively, in the intermediate-performance group (10% < ADR < 14%) and lower-performance group (ADR < 10%) in comparison with only 12.9% in the high-performance group (ADR > 14%). There was a significant linear trend between the proportion scored as having poor bowel preparation and the ADR (P < 0.001), varying from 2.7% in the higher-performance ADR group to 13.4% in the lower-performance group.Conclusions: Endoscopists with a higher ADR are more likely to be critical of the quality of bowel preparation. Training in judgement processes such as nonacceptance of suboptimal bowel preparation is required in order to ensure universally high standards in screening procedures.