Department of Gastroenterology, Centre hospitalo-universitaire, Rennes, France.
Gastrointest Endosc. 2010 Feb;71(2):335-41. doi: 10.1016/j.gie.2009.08.032. Epub 2009 Nov 17.
There are few data about the performance variability among endoscopists participating to nationwide or regionwide colorectal cancer screening programs.
To assess the variability of neoplasia detection rates among endoscopists participating in a regional colorectal cancer screening program based on colonoscopy after biennial fecal occult blood testing (FOBT).
Two rounds of colonoscopy were performed: round 1 took place in 2003 and 2004, and round 2 took place in 2005 and 2006. Secondary analysis of colonoscopy findings from the first 2 rounds was performed by using data drawn from all endoscopists who performed more than 30 colonoscopies in each round. Detection rates were adjusted for patient age and sex, and logistic regression analyses were conducted including these 2 variables and round number (1 or 2).
District of Ille-et-Vilaine in Brittany (population >900,000) between 2003 and 2007.
The per-endoscopist adjusted rates of colonoscopies with at least 1, 2, or 3 adenomas, 1 adenoma 10 mm or larger, or a cancer.
Among the 18 endoscopists who performed 3462 colonoscopies, the adjusted detection rates were in the following ranges: at least 1 adenoma, 25.4% to 46.8%; 2 adenomas, 5.1% to 21.7%; 3 adenomas, 2.7% to 12.4%; 1 adenoma 10 mm or larger, 14.2% to 28.0%; and cancer, 6.3% to 16.4%. Multivariate analyses showed that the endoscopist was not an independent predictor of cancer detection, but was an independent predictor of detecting adenomas, regardless of category; the R(2) of the models ranged from 6% to 13% only.
Other factors known to influence colorectal neoplasia occurrence and withdrawal time could not be taken into account.
In a screening program with a high compliance rate with colonoscopy after FOBT, interendoscopist variability had no effect on cancer detection, but did influence identification of adenomas. The clinical impact of such findings merits further evaluation.
关于参与全国或地区性结直肠癌筛查项目的内镜医师之间的表现变异性，数据较少。
评估在基于每两年粪便潜血试验（FOBT）后的结肠镜检查的区域性结直肠癌筛查计划中，内镜医师之间的腺瘤检出率的变异性。
进行了两轮结肠镜检查：第一轮在 2003 年和 2004 年进行，第二轮在 2005 年和 2006 年进行。对前两轮结肠镜检查结果进行了二次分析，使用了在每轮检查中进行超过 30 次结肠镜检查的所有内镜医师的数据。调整了患者年龄和性别对检出率的影响，并进行了包括这两个变量和轮次（1 或 2）的逻辑回归分析。
2003 年至 2007 年间，布列塔尼的伊勒-维莱讷区（人口超过 900,000）。
每位内镜医师调整后的结肠镜检查中至少检出 1 个、2 个或 3 个腺瘤、1 个 10mm 或更大的腺瘤或癌症的检出率。
在进行了 3462 次结肠镜检查的 18 名内镜医师中，调整后的检出率如下：至少检出 1 个腺瘤，25.4%至 46.8%；2 个腺瘤，5.1%至 21.7%；3 个腺瘤，2.7%至 12.4%；1 个 10mm 或更大的腺瘤，14.2%至 28.0%；癌症，6.3%至 16.4%。多变量分析表明，内镜医师不是癌症检出的独立预测因素，但无论分类如何，都是检出腺瘤的独立预测因素；模型的 R²仅为 6%至 13%。
无法考虑其他已知会影响结直肠腺瘤发生和退出时间的因素。
在 FOBT 后结肠镜检查的高顺应性筛查计划中，内镜医师之间的变异性对癌症的检出没有影响，但确实影响了腺瘤的检出。这些发现的临床影响值得进一步评估。
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