Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA.
Gastrointest Endosc. 2012 Mar;75(3):554-60. doi: 10.1016/j.gie.2011.11.021.
Adenoma detection rate is an important measure of colonoscopy quality; however, factors including procedure order that contribute to adenoma detection are incompletely understood.
The aim of this study was to prospectively evaluate factors associated with adenoma detection rate.
Prospective cohort study. Data were collected on patient and physician characteristics, trainee participation, time of day, and case rank.
Outpatient tertiary-care center.
This study involved consecutive patients presenting for first screening colonoscopies.
Adenoma and polyp detection rates (proportion of cases with one or more lesion detected) and ratios (mean number of lesions detected per case).
A total of 2139 colonoscopies were performed by 32 gastroenterologists. Detection rates were 42.7% for all polyps, 25.4% for adenomas, and 5.0% for advanced adenomas. Adenoma detection was associated with male sex and increasing age on multivariate analysis. In the overall study cohort, time of day and case rank were not significantly associated with detection rates. In post hoc analysis, polyp and adenoma detection rates appeared lower after the fifth case of the day for endoscopists with low volumes of cases and after the tenth case of the day for endoscopists with high volumes of cases.
Single center.
Overall, time of day and case rank did not influence adenoma detection rate. We observed a small but significant decrease in detection rates in later procedures, which was dependent on physician typical procedure volume. These findings imply that colonoscopy quality in general is stable throughout the day; however, there may be a novel "stamina effect" for some endoscopists, and interventions aimed at improving colonoscopy quality need to take individual physician practice styles into consideration.
腺瘤检出率是结肠镜质量的重要衡量标准；然而，包括影响腺瘤检出的程序顺序在内的因素尚未完全明确。
本研究旨在前瞻性评估与腺瘤检出率相关的因素。
前瞻性队列研究。收集患者和医生特征、培训医师参与情况、检查时间和病例分级等数据。
门诊三级保健中心。
本研究纳入连续就诊行首次筛查结肠镜的患者。
腺瘤和息肉检出率（检出一个或多个病变的病例比例）和检出率比值（每例检出的病变平均数量）。
32 名胃肠病医师共进行了 2139 例结肠镜检查。所有息肉的检出率为 42.7%，腺瘤为 25.4%，高级别腺瘤为 5.0%。多变量分析显示，腺瘤检出与男性和年龄增长相关。在整个研究队列中，检查时间和病例分级与检出率无显著相关性。在事后分析中，对于低例数医师，当天第五例以后，以及对于高例数医师，当天第十例以后，息肉和腺瘤的检出率似乎较低。
单中心。
总体而言，检查时间和病例分级未影响腺瘤检出率。我们观察到，当天较晚的检查中，检出率略有但有统计学意义的下降，这与医师的典型检查例数相关。这些发现提示，一般而言，结肠镜质量全天较为稳定；然而，对于某些内镜医师，可能存在新的“体力效应”，改善结肠镜质量的干预措施需要考虑到个体医师的实践风格。
