Colonoscopy quality measures: experience from the NHS Bowel Cancer Screening Programme
Colonoscopy quality measures: experience from the NHS Bowel Cancer Screening Programme
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DOI：
10.1136/gutjnl-2011-300651
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发表时间：
2012-07-01
期刊：
影响因子：
24.5
通讯作者：
Rees, Colin J.
中科院分区：
文献类型：
--
作者：
Lee, Thomas J. W.;Rutter, Matthew D.;Rees, Colin J.
目的结肠镜检查是结直肠癌（CRC）筛查的核心。CRC筛查的成功取决于结肠镜检查的质量。NHS肠癌筛查计划（BCSP）为60-74奥尔兹的人提供两年一次的粪便潜血（FOB）测试，并为FOB测试阳性的人提供结肠镜检查。筛查计划中的所有结肠镜医生都必须在开始筛查之前达到预定的标准，并受到持续的质量保证。在这项研究中，作者研究了NHS BCSP结肠镜检查的质量，并描述了新的和既定的措施，以评估和保持quality.Design NHS BCSP数据库收集所有筛查结肠镜检查的详细数据。分析了从该方案前3年（2006年8月至2009年8月）收集的数据。结肠镜质量指标（腺瘤检出率（ADR）、息肉检出率、结肠镜退出时间、盲肠插管率、直肠后倾率、息肉取出率、平均镇静剂量、患者舒适度评分、肠道准备质量和不良事件发生率）与总腺瘤检出率一起计算沿着。平均未经调整的盲肠插管率为95.2%，正常程序的平均停药时间为9.2分钟。平均ADR每结肠镜检查为46.5%。每个手术的平均腺瘤数量（MAP）为0.91;每个阳性手术的平均腺瘤数量（MAP+）为1.94。0.09%的手术后发生穿孔。没有出现与手术相关的死亡。结论NHS BCSP提供高质量的结肠镜检查，这体现在较高的盲肠插管率、ADR和舒适度评分以及较低的不良事件发生率。通过确保BCSP结肠镜医师在开始筛查前达到高标准并通过持续的质量保证来实现质量。测量总腺瘤检测（MAP和MAP+）作为ADR的指标可进一步提高质量保证。
Objectives Colonoscopy is central to colorectal cancer (CRC) screening. Success of CRC screening is dependent on colonoscopy quality. The NHS Bowel Cancer Screening Programme (BCSP) offers biennial faecal occult blood (FOB) testing to 60-74 year olds and colonoscopy to those with positive FOB tests. All colonoscopists in the screening programme are required to meet predetermined standards before starting screening and are subject to ongoing quality assurance. In this study, the authors examine the quality of colonoscopy in the NHS BCSP and describe new and established measures to assess and maintain quality.Design The NHS BCSP database collects detailed data on all screening colonoscopies. Prospectively collected data from the first 3 years of the programme (August 2006 to August 2009) were analysed. Colonoscopy quality indicators (adenoma detection rate (ADR), polyp detection rate, colonoscopy withdrawal time, caecal intubation rate, rectal retroversion rate, polyp retrieval rate, mean sedation doses, patient comfort scores, bowel preparation quality and adverse event incidence) were calculated along with measures of total adenoma detection.Results 2 269 983 individuals returned FOB tests leading to 36 460 colonoscopies. Mean unadjusted caecal intubation rate was 95.2%, and mean withdrawal time for normal procedures was 9.2 min. The mean ADR per colonoscopist was 46.5%. The mean number of adenomas per procedure (MAP) was 0.91; the mean number of adenomas per positive procedure (MAP+) was 1.94. Perforation occurred after 0.09% of procedures. There were no procedure-related deaths.Conclusions The NHS BCSP provides high-quality colonoscopy, as demonstrated by high caecal intubation rate, ADR and comfort scores, and low adverse event rates. Quality is achieved by ensuring BCSP colonoscopists meet a high standard before starting screening and through ongoing quality assurance. Measuring total adenoma detection (MAP and MAP+) as adjuncts to ADR may further enhance quality assurance.