Failure of colonoscopy to detect colorectal cancer: Evaluation of 47 cases in 20 hospitals
Failure of colonoscopy to detect colorectal cancer: Evaluation of 47 cases in 20 hospitals
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DOI：
10.1016/s0016-5107(97)70172-x
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发表时间：
1997-06-01
影响因子：
7.7
通讯作者：
Rex, DK
中科院分区：
文献类型：
--
作者：
Haseman, JH;Lemmel, GT;Rex, DK
背景：结肠镜检查是检查结肠息肉和结肠癌的金标准，但检查失败时有发生，其原因尚不完全清楚。方法：在回顾性评估20家印第安纳医院的钡灌肠和结肠镜检查的敏感性时，我们遇到了47例结直肠癌患者，这些患者在诊断后3年内进行结肠镜检查未发现癌症。病例回顾肿瘤的位置，减轻因素，病理特征，诊断延误从失败的检测，谁进行了检查。结果：由非天文学专家进行结肠镜检查比由胃肠病学专家进行结肠镜检查更容易失败（优势比为5:36,95% CI[2.94,9.77]）。27例癌症“未被发现”，20例估计未被发现。然而，遗漏肿瘤的位置和盲肠插管的普遍缺乏充分的文件表明，一些记录为遗漏的盲肠和升结肠癌实际上可能没有被发现。胃肠病学家之间的敏感性差异表明，细致的检查对于最大限度地提高敏感性也很重要。结论：这些病例提示了几个可能提高结肠镜检查质量和灵敏度的因素：(1)检查人员应接受足够的培训；(2)盲肠插管率应高；(3)盲肠插管应在所有病例中通过特定的标志进行验证；(4)盲肠未到达应及时进行钡灌肠；(5)细致的检查似乎可以提高对癌症检测的敏感性。
Background: Colonoscopy is the gold standard for the detection of colon polyps and cancers, but failed detections can occur and the reasons are incompletely understood.Methods: During a retrospective evaluation of the sensitivity of barium enema and colonoscopy in 20 Indiana Hospitals, we encountered 47 cases of colorectal cancer in which a colonoscopy performed within 3 years of the diagnosis had not detected the cancer. Cases were reviewed for location of tumor, extenuating factors, pathologic features, delay in diagnosis from failed detection, and who performed the examination.Results: Failed detection was more likely when colonoscopy was performed by a nongastroenterologist than a gastroenterologist (odds ratio 5:36, 95% CI [2.94,9.77]). Twenty-seven cancers were ''missed,'' and 20 were estimated to be not reached. However, the location of missed tumors and a general absence of adequate documentation of cecal intubation suggested that some cecal and ascending colon cancers recorded as missed may actually have been not reached. Variation in sensitivity among gastroenterologists suggested that meticulous examination is also important in maximizing sensitivity.Conclusions: These cases suggest several factors that might improve the quality and sensitivity of colonoscopy: (1) examiners should receive adequate training, (2) cecal intubation rates should be high, (3) cecal intubation should be verified by specific landmarks in all cases, (4) failure to reach the cecum should be followed by prompt barium enema, and (5) meticulous examination would appear to improve sensitivity for cancer detection.