Quality of colonoscopy withdrawal technique and variability in adenoma detection rates
Quality of colonoscopy withdrawal technique and variability in adenoma detection rates
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DOI：
10.1016/j.gie.2011.03.003
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发表时间：
2011-07-01
影响因子：
7.7
通讯作者：
Savides, Thomas J.
中科院分区：
文献类型：
--
作者：
Lee, Robert H.;Tang, Raymond S.;Savides, Thomas J.
背景：研究表明，结肠镜检查停药时间等内窥镜医生相关因素对于确定腺瘤检出率 (ADR) 非常重要。目的：确定停药技术在区分不同 ADR 的内窥镜医生中的重要性。设计：前瞻性、多中心研究。地点：五个学术三级医疗中心。参与者：这项研究涉及 11 名胃肠病学教员 干预：对筛查结肠镜检查进行回顾性审查，将内窥镜医师分为低、中和高 ADR 组。在进行平均风险结直肠癌筛查的结肠镜检查期间，为每位内窥镜医师随机获取 20 次（10 次真实，10 次假）退出的视频记录。三名盲审员对 110 个视频记录进行了戒断技巧评分（共 75 分）。另一位评审员记录了戒断时间。主要结果测量：戒断技术评分和戒断时间。结果：中度 (62 ± 2.5) 和高 (59.5 +/- 3) ADR 组的平均戒断技术评分高于低 (40.8 +/- 3) ADR 组 (P = .002)。平均（+/- SD）撤药时间为 6.3 +/- 1.8 分钟（低 ADR）、10.2 +/- 1.5 分钟（中 ADR）和 8.2 +/- 1.8 分钟（高 ADR）（P = .29）。对具有最低和最高 ADR 的两位内窥镜医师的撤药时间和技术评分进行比较，没有发现撤药时间存在显着差异（6.6 +/- 1.7 与 7.4 +/- 1.7 分钟）（P = .36），但确实发现技术评分有近 2 倍的差异（36.2 +/- 9 与 62.8 +/- 9.9）（P = .0001）。 局限性：无动力充足 检测撤药时间的微小差异。结论：撤药技术是区分不同内镜医师的重要指标。美国存托凭证。在确定 ADR 时，停药技术可能与停药时间同等重要，甚至更重要。 （胃肠测试 Endosc 2011；74：128-34。）
Background: Studies suggest that endoscopist-related factors such as colonoscopy withdrawal time are important in determining the adenoma detection rate (ADR).Objective: To determine the importance of withdrawal technique in differentiating among endoscopists with varying ADRs.Design: Prospective, multicenter study.Setting: Five academic tertiary-care medical centers.Participants: This study involved 11 gastroenterology faculty endoscopists.Intervention: A retrospective review of screening colonoscopies was performed to categorize endoscopists into low, moderate, and high ADR groups. Video recordings were randomly obtained for each endoscopist on 20 (10 real, 10 sham) withdrawals during colonoscopies performed for average-risk colorectal cancer screening. Three blinded reviewers assigned withdrawal technique scores (total of 75 points) on 110 video recordings. A separate reviewer recorded withdrawal times.Main Outcome Measurements: Withdrawal technique scores and withdrawal times.Results: Mean ( standard deviation [SD]) withdrawal technique scores were higher in the moderate (62 2.5) and high (59.5 +/- 3) ADR groups compared with the low (40.8 +/- 3) ADR group (P = .002). Mean (+/- SD) withdrawal times were 6.3 +/- 1.8 minutes (low ADR), 10.2 +/- 1.5 minutes (moderate ADR), and 8.2 +/- 1.8 minutes (high ADR) (P = .29). A comparison of the withdrawal times and technique scores of the two individual endoscopists with the lowest and highest ADRs did not find a significant difference in withdrawal times (6.6 +/- 1.7 vs 7.4 +/- 1.7 minutes) (P = .36) but did find a nearly 2-fold difference in technique scores (36.2 +/- 9 vs 62.8 +/- 9.9) (P = .0001).Limitations: Not adequately powered to detect small differences in withdrawal times.Conclusion: Withdrawal technique is an important indicator that differentiates between endoscopists with varying. ADRs. It is possible that withdrawal technique is equal to, if not more important than, withdrawal time in determining ADRs. (Gastrointest Endosc 2011;74:128-34.)