Quality indicators for colonoscopy
Quality indicators for colonoscopy
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DOI：
10.1016/j.gie.2014.07.058
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发表时间：
2015-01-01
影响因子：
7.7
通讯作者：
Weinberg, David S.
中科院分区：
文献类型：
--
作者：
Rex, Douglas K.;Schoenfeld, Philip S.;Weinberg, David S.
结肠镜检查广泛用于结肠疾病的诊断和治疗。正确进行，结肠镜检查通常是安全的，准确的，耐受性良好。在结肠镜检查过程中，整个大肠和末端回肠的粘膜通常可以显示。息肉可以在结肠镜检查中去除，从而降低结肠癌的风险。结肠镜检查是评价大多数患有大肠症状、缺铁性贫血、结肠放射学检查结果异常、结直肠癌（CRC）筛查试验结果阳性、息肉切除术后和癌切除术后监测以及炎症性肠病诊断和监测的成年患者结肠的首选方法。此外，结肠镜检查是美国最常用的CRC筛查测试（1）。根据2010年的数据，美国每年进行超过330万次门诊结肠镜检查，筛查和息肉监测占适应症的一半（2）。结肠镜检查的最佳效果取决于患者对该程序的接受程度，这主要取决于肠道准备的接受程度（3）。准备质量影响检查的完整性，程序持续时间，以及在比其他情况下需要更早的日期取消或重复程序的需要（4，5）。无效的准备是成本的主要贡献者（6）。腺瘤检查（7，8）和较长的停药时间（9，10，11，12，13，14）与较高的腺瘤检出率（ADR）相关。高ADR对于使筛选和监测检查之间的推荐间隔（15）安全（16，17）至关重要。当炎症性肠病中存在异型增生时，需要最佳技术来确保检测异型增生的高概率（17，18，19，20，21）。最后，技术专业知识和经验将有助于防止可能抵消去除肿瘤病变的益处的不良事件（22）。
Colonoscopy is widely used for the diagnosis and treatment of colon disorders. Properly performed, colonoscopy is generally safe, accurate, and well-tolerated. Visualization of the mucosa of the entire large intestine and distal terminal ileum usually is possible during colonoscopy. Polyps can be removed during colonoscopy, thereby reducing the risk of colon cancer. Colonoscopy is the preferred method to evaluate the colon in most adult patients with large-bowel symptoms, iron deficiency anemia, abnormal results on radiographic studies of the colon, positive results on colorectal cancer (CRC) screening tests, post-polypectomy and post-cancer resection surveillance, and diagnosis and surveillance in inflammatory bowel disease. In addition, colonoscopy is the most commonly used CRC screening test in the United States (1). Based on 2010 data, over 3.3 million outpatient colonoscopies are performed annually in the United States, with screening and polyp surveillance accounting for half of indications (2).Optimal effectiveness of colonoscopy depends on patient acceptance of the procedure, which depends mostly on acceptance of the bowel preparation (3). Preparation quality affects the completeness of examination, procedure duration, and the need to cancel or repeat procedures at earlier dates than would otherwise be needed (4, 5). Ineffective preparation is a major contributor to costs (6). Meticulous inspection (7, 8) and longer withdrawal times (9, 10, 11, 12, 13, 14) are associated with higher adenoma detection rates (ADR). A high ADR is essential to rendering recommended intervals (15) between screening and surveillance examinations safe (16, 17). Optimal technique is needed to ensure a high probability of detecting dysplasia when present in inflammatory bowel disease (17, 18, 19, 20, 21). Finally, technical expertise and experience will help prevent adverse events that might offset the benefits of removing neoplastic lesions (22).