Serrated and adenomatous polyp detection increases with longer withdrawal time: results from the New Hampshire Colonoscopy Registry.
Serrated and adenomatous polyp detection increases with longer withdrawal time: results from the New Hampshire Colonoscopy Registry.
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DOI：
10.1038/ajg.2013.442
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发表时间：
2014-03
影响因子：
9.8
通讯作者：
Beach, Michael L.
中科院分区：
文献类型：
--
作者：
Butterly, Lynn;Robinson, Christina M.;Anderson, Joseph C.;Weiss, Julia E.;Goodrich, Martha;Onega, Tracy L.;Amos, Christopher I.;Beach, Michael L.
检测和切除腺瘤和临床上显著的锯齿状息肉对结肠镜检查预防结直肠癌的有效性至关重要。虽然已发现较长的停药时间可增加息肉检测，但这种关联以及将停药时间用作质量指标仍然存在争议。很少有研究报告停药时间和锯齿状息肉检测。利用来自新罕布什尔州结肠镜登记处的数据，我们研究了内镜医师在正常结肠镜检查中的退出时间如何影响腺瘤和锯齿状息肉的检出。我们分析了2009年至2011年期间由14家医院、门诊手术中心和社区诊所的42名内镜医师对7972例患者进行的7996次结肠镜检查。临床显著性锯齿状息肉（CSSP）定义为无蒂锯齿状息肉和乙状结肠近端增生性息肉。腺瘤和CSSP的检出率是根据正常检查中内镜医师退出时间的中位数计算的。回归模型用于估计正常戒断时间增加与息肉、腺瘤和CSSP检测的相关性。息肉和腺瘤的检出率最高的内镜医生与9分钟的中位数正常撤出时间，而CSSP的检测达到最高水平，在8至9分钟。腺瘤和CSSP检测的发生率比随着正常停药时间超过6分钟而增加，腺瘤（1.50，95% CI（1.21，1.85））和CSSP（1.77，95% CI（1.15，2.72））在9分钟时获益最大。当使用建模将最短停药时间设定为9分钟时，我们预测将在302例（3.8%）和191例（2.4%）患者中检测到腺瘤和CSSP。检测的增加对于CSSP来说是最引人注目的，相对增加了近30%。9分钟的停药时间导致腺瘤和锯齿状息肉检测的统计学显著增加。结肠镜检查的质量可能会提高，平均正常退出时间基准为9分钟。
Detection and removal of adenomas and clinically significant serrated polyps is critical to the effectiveness of colonoscopy in preventing colorectal cancer. While longer withdrawal time has been found to increase polyp detection, this association, and the use of withdrawal time as a quality indicator, remains controversial. Few studies have reported on withdrawal time and serrated polyp detection. Using data from the New Hampshire Colonoscopy Registry, we examined how an endoscopist’s withdrawal time in normal colonoscopies affects adenoma and serrated polyp detection. We analyzed 7996 colonoscopies performed in 7972 patients between 2009 and 2011 by 42 endoscopists at 14 hospitals, ambulatory surgery centers, and community practices. Clinically significant serrated polyps (CSSPs) were defined as sessile serrated polyps and hyperplastic polyps proximal to the sigmoid. Adenoma and CSSP detection rates were calculated based on median endoscopist withdrawal time in normal exams. Regression models were used to estimate the association of increased normal withdrawal time and polyp, adenoma, and CSSP detection. Polyp and adenoma detection rates were highest among endoscopists with 9 minute median normal withdrawal time, while detection of CSSPs reached its highest levels at 8 to 9 minutes. Incident rate ratios for adenoma and CSSP detection increased with each minute of normal withdrawal time above 6 minutes, with maximum benefit at 9 minutes for adenomas (1.50, 95% CI (1.21,1.85)) and CSSPs (1.77, 95% CI (1.15, 2.72)). When modeling was used to set the minimum withdrawal time at 9 minutes, we predicted that adenomas and CSSPs would be detected in 302 (3.8%) and 191 (2.4%) more patients. The increase in detection was most striking for the CSSPs, with nearly a 30% relative increase. A withdrawal time of 9 minutes resulted in a statistically significant increase in adenoma and serrated polyp detection. Colonoscopy quality may improve with a median normal withdrawal time benchmark of 9 minutes.
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