Chen Shawn C, Rex Douglas K
Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, USA.
Am J Gastroenterol. 2007 Apr;102(4):856-61. doi: 10.1111/j.1572-0241.2006.01054.x. Epub 2007 Jan 11.
Both advancing age and male gender are known predictors of adenomas and large adenomas at colonoscopy. However, the importance of endoscopist compared with both age and gender as predictors of adenomas is not known. In this study, we assessed the adenoma detection rates of nine endoscopists performing colonoscopy and the effects of endoscopist on adenoma detection compared with the established predictors of advancing age and male gender.
Consecutive colonoscopy reports by nine attending gastroenterologists at Indiana University Hospital between January 1999 and January 2004 were obtained. Patients with indications for inflammatory bowel disease (IBD), inherited colon cancer syndromes, or who were referred for polypectomy were excluded.
There were 10,034 included colonoscopies. The overall mean age (yr) +/- SD for the entire cohort was 56.0 +/- 13.5, range 14-93 yr. Multivariate analysis indicated that both advancing age and male gender were powerful predictors of adenomas, both for the overall cohort and in those >or=50 of age (P<or= 0.0001). The prevalence of adenomas increased from 14.6% at age 30 to 35.2% at age 70. Men had more adenomas than women (24.4%vs 16.6%, P<or= 0.0001). Among patients >or=50 yr of age, the range of detection of at least one adenoma per colonoscopy by nine colonoscopists was 15.5-41.1%, at least two adenomas was 4.9-20.0%, at least three adenomas was 0.8-10.8%, and at least one adenoma >or=1.0 cm was 1.7-6.2%, and the range of adenomas detected per colonoscopy was 0.21-0.86. Differences between endoscopists were significant (P < 0.001).
Who performs the procedure can be more important than age and gender in predicting adenomas at colonoscopy. Our results underscore the need to measure adenoma detection rates in the continuous quality improvement process and to report them to endoscopists. Additional data are needed to determine whether corrective measures can reduce variation in adenoma detection rates.
年龄增长和男性性别都是结肠镜检查时腺瘤及大腺瘤的已知预测因素。然而，与年龄和性别相比，内镜医师作为腺瘤预测因素的重要性尚不清楚。在本研究中，我们评估了9名进行结肠镜检查的内镜医师的腺瘤检出率，以及与已确定的年龄增长和男性性别预测因素相比，内镜医师对腺瘤检出的影响。
获取了1999年1月至2004年1月期间印第安纳大学医院9名胃肠病学主治医生的连续结肠镜检查报告。排除有炎症性肠病（IBD）、遗传性结肠癌综合征指征或因息肉切除术而转诊的患者。
纳入10,034例结肠镜检查。整个队列的总体平均年龄（岁）±标准差为56.0±13.5，年龄范围为14 - 93岁。多变量分析表明，年龄增长和男性性别都是腺瘤的有力预测因素，无论是对于整个队列还是年龄≥50岁的人群（P≤0.0001）。腺瘤患病率从30岁时的14.6%增至70岁时的35.2%。男性的腺瘤比女性多（24.4%对16.6%，P≤0.0001）。在年龄≥50岁的患者中，9名结肠镜检查医师每次结肠镜检查至少检出1个腺瘤的范围为15.5% - 41.1%，至少检出2个腺瘤的范围为4.9% - 20.0%，至少检出3个腺瘤的范围为0.8% - 10.8%，至少检出1个腺瘤≥1.0 cm的范围为1.7% - 6.2%，每次结肠镜检查检出腺瘤的范围为0.21 - 0.86。内镜医师之间的差异具有显著性（P < 0.001）。
在结肠镜检查腺瘤预测方面，谁来操作检查可能比年龄和性别更重要。我们的结果强调在持续质量改进过程中测量腺瘤检出率并将其报告给内镜医师的必要性。需要更多数据来确定纠正措施是否能减少腺瘤检出率的差异。
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