Impact of Colonoscopy Bowel Preparation Quality on Follow-up Interval Recommendations for Average-risk Patients With Normal Screening Colonoscopies: Data From the New Hampshire Colonoscopy Registry.
Impact of Colonoscopy Bowel Preparation Quality on Follow-up Interval Recommendations for Average-risk Patients With Normal Screening Colonoscopies: Data From the New Hampshire Colonoscopy Registry.
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DOI：
10.1097/mcg.0000000000001115
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发表时间：
2020-04
影响因子：
2.9
通讯作者：
Shapiro JA
中科院分区：
文献类型：
--
作者：
Butterly LF;Nadel MR;Anderson JC;Robinson CM;Weiss JE;Lieberman D;Shapiro JA
国家结肠镜筛查和监测指南假定肠道准备充分。我们使用新罕布什尔州结肠镜登记处（NHCR）的数据，研究肠道准备质量对内镜医师建议的正常筛查结肠镜检查后的平均风险患者的随访间隔的影响。该分析包括2005年2月至2013年9月期间对50岁及以上的平均风险人群进行的9170次正常筛查结肠镜检查。NHCR程序表指示内镜医师在清除所有结肠节段后根据最差准备节段进行评分，使用以下类别：极好（基本上100%可视化）、良好（非常不可能损害可视化）、一般（可能损害可视化）和差（明确损害可视化）。我们将检查分为3个准备组：最佳（优秀/良好）（n = 8453）、一般（n = 598）和较差（n = 119）。对于最佳准备的检查，建议10年以上，对于准备不佳的检查，建议> 1年，被视为不遵守。在所有检查中，总体上有6.2%的检查收到了不遵守的建议，包括5%的准备最佳的检查和89.9%的准备较差的检查。在准备良好的正常检查中，20.7%的建议间隔时间<10年。在那些准备良好的检查中，较短间隔的建议与女性、既往/非吸烟者和腺瘤检出率≥ 20%的内镜医师相关。在8453例采用最佳准备的结肠镜检查中，大多数建议（95%）符合指南。目前还没有关于公平准备的指南建议，但在这项对社区实践的调查中，公平准备小组的大多数成员都收到了10年的后续建议。准备不充分的检查中，接受随访建议的比例明显高于1年指南建议。提供者的教育是必要的，以确保病人的肠道准备不良，适当的后续减少风险的重要病变。
National guidelines for colonoscopy screening and surveillance assume adequate bowel preparation. We used New Hampshire Colonoscopy Registry (NHCR) data to investigate the influence of bowel preparation quality on endoscopist recommendations for follow-up intervals in average-risk patients following normal screening colonoscopies. The analysis included 9170 normal screening colonoscopies performed on average risk individuals aged 50 and above between February 2005 and September 2013. The NHCR Procedure Form instructs endoscopists to score based on the worst prepped segment after clearing all colon segments, using the following categories: excellent (essentially 100% visualization), good (very unlikely to impair visualization), fair (possibly impairing visualization), and poor (definitely impairing visualization). We categorized examinations into 3 preparation groups: optimal (excellent/good) (n = 8453), fair (n = 598), and poor (n = 119). Recommendations other than 10 years for examinations with optimal preparation, and > 1 year for examinations with poor preparation, were considered nonadherent. Of all examinations, 6.2% overall received nonadherent recommendations, including 5% of examinations with optimal preparation and 89.9% of examinations with poor preparation. Of normal examinations with fair preparation, 20.7% of recommendations were for an interval <10 years. Among those examiations with fair preparation, shorter-interval recommendations were associated with female sex, former/nonsmokers, and endoscopists with adenoma detection rate ≥ 20%. In 8453 colonoscopies with optimal preparations, most recommendations (95%) were guideline-adherent. No guideline recommendation currently exists for fair preparation, but in this investigation into community practice, the majority of the fair preparation group received 10-year follow-up recommendations. A strikingly high proportion of examinations with poor preparation received a follow-up recommendation greater than the 1-year guideline recommendation. Provider education is needed to ensure that patients with poor bowel preparation are followed appropriately to reduce the risk of missing important lesions.