Division of Gastroenterology, University of California Irvine, Irvine, California, USA; Gastroenterology Section, Veterans Affairs Long Beach Health Care System, Long Beach, California, USA.
Gastrointest Endosc. 2011 Jul;74(1):128-34. doi: 10.1016/j.gie.2011.03.003. Epub 2011 Apr 30.
Studies suggest that endoscopist-related factors such as colonoscopy withdrawal time are important in determining the adenoma detection rate (ADR).
To determine the importance of withdrawal technique in differentiating among endoscopists with varying ADRs.
Prospective, multicenter study.
Five academic tertiary-care medical centers.
This study involved 11 gastroenterology faculty endoscopists.
A retrospective review of screening colonoscopies was performed to categorize endoscopists into low, moderate, and high ADR groups. Video recordings were randomly obtained for each endoscopist on 20 (10 real, 10 sham) withdrawals during colonoscopies performed for average-risk colorectal cancer screening. Three blinded reviewers assigned withdrawal technique scores (total of 75 points) on 110 video recordings. A separate reviewer recorded withdrawal times.
Withdrawal technique scores and withdrawal times.
Mean (± standard deviation [SD]) withdrawal technique scores were higher in the moderate (62 ± 2.5) and high (59.5 ± 3) ADR groups compared with the low (40.8±3) ADR group (P = .002). Mean (± SD) withdrawal times were 6.3 ± 1.8 minutes (low ADR), 10.2 ± 1.5 minutes (moderate ADR), and 8.2 ± 1.8 minutes (high ADR) (P = .29). A comparison of the withdrawal times and technique scores of the two individual endoscopists with the lowest and highest ADRs did not find a significant difference in withdrawal times (6.6 ± 1.7 vs 7.4 ± 1.7 minutes) (P = .36) but did find a nearly 2-fold difference in technique scores (36.2 ± 9 vs 62.8 ± 9.9) (P = .0001).
Not adequately powered to detect small differences in withdrawal times.
Withdrawal technique is an important indicator that differentiates between endoscopists with varying ADRs. It is possible that withdrawal technique is equal to, if not more important than, withdrawal time in determining ADRs.
研究表明，与内镜医生相关的因素，如结肠镜退镜时间，在确定腺瘤检出率（ADR）方面很重要。
确定退镜技术在区分不同 ADR 内镜医生中的重要性。
前瞻性、多中心研究。
五家学术性三级保健医疗中心。
这项研究涉及 11 名胃肠病学教授级内镜医生。
对筛查性结肠镜检查进行回顾性分析，将内镜医生分为低、中、高 ADR 组。在对平均风险结直肠癌筛查进行的结肠镜检查中，随机获取每位内镜医生 20 次（10 次真实、10 次模拟）退镜的录像。3 名盲法评审员对 110 段录像进行退镜技术评分（共 75 分）。另一名评审员记录退镜时间。
退镜技术评分和退镜时间。
中（62±2.5）和高（59.5±3）ADR 组的平均（±标准差[SD]）退镜技术评分高于低（40.8±3）ADR 组（P=0.002）。低（6.3±1.8 分钟）、中（10.2±1.5 分钟）和高（8.2±1.8 分钟）ADR 组的平均（±SD）退镜时间差异无统计学意义（P=0.29）。比较 ADR 最低和最高的两位内镜医生的退镜时间和技术评分，发现退镜时间无显著差异（6.6±1.7 与 7.4±1.7 分钟）（P=0.36），但技术评分差异近 2 倍（36.2±9 与 62.8±9.9）（P=0.0001）。
检测退镜时间微小差异的能力不足。
退镜技术是区分不同 ADR 内镜医生的一个重要指标。退镜技术在确定 ADR 方面的重要性可能与退镜时间相等，甚至更重要。
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