Lieberman David A, Holub Jennifer, Eisen Glenn, Kraemer Dale, Morris Cynthia D
Division of Gastroenterology; Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon 97239, USA.
Gastrointest Endosc. 2005 Dec;62(6):875-83. doi: 10.1016/j.gie.2005.06.037.
To assess capacity for colonoscopy, we need to understand current utilization of colonoscopy in diverse clinical practice settings. The objective of this study was to determine the utilization of colonoscopy in diverse clinical practice settings.
The Clinical Outcomes Research Initiative (CORI) data repository, which receives endoscopy reports from 73 diverse adult practice sites in the United States was used. Colonoscopy reports from January 2000 to August 2002 were analyzed to determine the demographic characteristics of adult patients who received a colonoscopy and the procedure indication. The relationship of age, race, gender, and procedure indication was analyzed.
Results of colonoscopies in 146,457 unique patients were analyzed. Of the reports, 68% came from nonacademic settings. Patients less than 50 years of age accounted for 20% of colonoscopies. The most common indications were rectal bleeding (33.6%), irritable bowel symptoms (23.8%), or screening because of a positive family history of colorectal cancer (22.4%) and screening with a primary colonoscopy or a fecal occult blood test (FOBT) (12.8%). In patients 50 years and older, asymptomatic screening (average-risk screening colonoscopy, positive family history, or FOBT positivity) accounted for 38.1% of all colonoscopies. Surveillance colonoscopy in patients with previous cancer or polyps accounted for 21.9% of colonoscopies performed in this age group. Differences in utilization were noted, based on gender and race.
Colonoscopy utilization varies based on age, gender, and race. Colonoscopy often is performed in patients less than 50 years old for irritable bowel symptoms; rectal bleeding; or average-risk screening, for which benefits are uncertain. In patients older than 50 years, surveillance after polyp removal is a common indication and may be overused. Understanding utilization can lead to further study to determine outcomes, to optimize utilization, and to provide a basis for shifting limited resources.
为评估结肠镜检查的能力，我们需要了解结肠镜检查在不同临床实践环境中的当前使用情况。本研究的目的是确定结肠镜检查在不同临床实践环境中的使用情况。
使用临床结果研究倡议（CORI）数据存储库，该存储库接收来自美国73个不同成人医疗机构的内镜检查报告。分析2000年1月至2002年8月的结肠镜检查报告，以确定接受结肠镜检查的成年患者的人口统计学特征和检查指征。分析年龄、种族、性别与检查指征之间的关系。
分析了146,457例独特患者的结肠镜检查结果。其中，68%的报告来自非学术机构。年龄小于50岁的患者占结肠镜检查的20%。最常见的检查指征是直肠出血（33.6%）、肠易激症状（23.8%）、因结直肠癌家族史阳性而进行的筛查（22.4%）以及初次结肠镜检查或粪便潜血试验（FOBT）筛查（12.8%）。在50岁及以上的患者中，无症状筛查（平均风险筛查结肠镜检查、家族史阳性或FOBT阳性）占所有结肠镜检查的38.1%。既往有癌症或息肉患者的监测结肠镜检查占该年龄组结肠镜检查的21.9%。基于性别和种族，注意到了使用情况的差异。
结肠镜检查的使用因年龄、性别和种族而异。对于肠易激症状、直肠出血或平均风险筛查（其益处尚不确定），结肠镜检查常在年龄小于50岁的患者中进行。在50岁以上的患者中，息肉切除后的监测是常见的检查指征，可能存在过度使用的情况。了解使用情况有助于进一步研究以确定结果、优化使用，并为分配有限资源提供依据。
