Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida 32224, USA.
Gastrointest Endosc. 2011 Jun;73(6):1223-31. doi: 10.1016/j.gie.2011.01.060. Epub 2011 Apr 8.
Previous studies examining the effect of fellow participation on adenoma detection rate in colonoscopy have yielded conflicting results, and factors such as adenoma size and location have not been rigorously evaluated.
To examine whether fellow participation during screening, surveillance, or diagnostic colonoscopy affects overall, size-specific, or location-specific adenoma or polyp detection rate.
This was a retrospective study of 2430 colonoscopies performed in our ambulatory surgical center between September 2006 and December 2007, comparing adenoma and polyp detection rates of colonoscopies performed by fellows with supervising staff endoscopists (n = 318) with colonoscopies performed by staff endoscopists without fellow participation (n = 2112). Study participants included patients who underwent screening, surveillance, or diagnostic colonoscopies in our GI suite. Logistic regression analysis was used to evaluate the association of fellow participation with adenoma and polyp detection.
There was evidence of a higher rate of small (<5 mm) adenoma detection in colonoscopies with a fellow present (25% vs 17%, P = .001). This remained significant after multiple-testing adjustment (P ≤ .003 considered significant). Findings were similar, although not significant for small polyps (36% vs 29%, P = .007). There was a trend toward increased adenoma detection in colonoscopies with a fellow present compared with those without (30% vs 26%, P = .11). Multivariable adjustment for potentially confounding variables did not alter these associations.
The study had a retrospective design, and information regarding bowel preparation was not available for 37% of patients.
Fellow involvement was associated with increased detection rates of small adenomas, providing evidence that the presence of a fellow during colonoscopy plays a role in enhancing the effectiveness of the examination.
之前研究同伴参与对结肠镜检查中腺瘤检出率的影响得出了相互矛盾的结果，并且腺瘤大小和位置等因素并未得到严格评估。
研究在筛查、监测或诊断性结肠镜检查中同伴参与是否会影响总体、大小特异性或位置特异性腺瘤或息肉的检出率。
这是一项回顾性研究，纳入了我们的日间手术中心于 2006 年 9 月至 2007 年 12 月期间进行的 2430 例结肠镜检查，比较了由带教医生和无同伴参与的主治医生进行的结肠镜检查的腺瘤和息肉检出率（分别为 318 例和 2112 例）。研究参与者包括在我们胃肠科接受筛查、监测或诊断性结肠镜检查的患者。采用逻辑回归分析评估同伴参与与腺瘤和息肉检出的关系。
有证据表明，有同伴在场的结肠镜检查中，小腺瘤（<5mm）的检出率更高（25%比 17%，P=0.001）。经过多次检验调整后，这一结果仍然具有统计学意义（P≤0.003 被认为有统计学意义）。对于小息肉，结果类似，但无统计学意义（36%比 29%，P=0.007）。与无同伴在场的结肠镜检查相比，有同伴在场的结肠镜检查中腺瘤的检出率有增加的趋势（30%比 26%，P=0.11）。对可能的混杂因素进行多变量调整并未改变这些关联。
本研究为回顾性设计，37%的患者的肠道准备信息不可用。
同伴参与与小腺瘤的检出率增加有关，这表明在结肠镜检查中存在同伴可以提高检查的效果。
