Lim Gary, Viney Sharon K, Chapman Bruce A, Frizelle Frank A, Gearry Richard B
Department of Gastroenterology, Christchurch Hospital, Christchurch, New Zealand.
N Z Med J. 2012 Jun 8;125(1356):52-9.
Studies have suggested that a colonoscopy withdrawal time of at least 6 minutes is associated with an increased adenoma detection rate in patients undergoing colorectal cancer screening.
We aimed to determine colonoscopy withdrawal time and rate of polyp detection in a blinded study--conducted at Christchurch Hospital (Christchurch, New Zealand)--to determine if there was a relationship.
All 16 consultant endoscopists performing colonoscopy in a tertiary hospital had their withdrawal time from the caecum prospectively timed over 208 consecutive procedures between 11 April 2007 and 19 May 2007. The following data was collected: indication for procedure, final diagnosis, polypectomy rate, procedures performed and withdrawal time were recorded. Histology results were reviewed for all patients.
111 (53%) of colonoscopies were performed for symptom assessment and 97 (47%) for surveillance. There was significant heterogeneity between colonoscopists' withdrawal times (p<0.001). Polyps were diagnosed in 65 of all colonoscopies (31.3%). Of the screening colonoscopies polyps were found in 38 (39.1%) of which 14 were adenomas (adenoma detection rate of 14%). The median colonoscopy withdrawal time was 3 minutes 16 seconds when no polyps were found (range 5 seconds to 11 minutes 50 seconds). The median colonoscopy time when polyps were found was 8 minutes 31 seconds which included time taken for procedures (range 2 minutes 7 seconds to 35 minutes 40 seconds), p<0.001.
This study confirms that more adenomas were found by those endoscopists who had slower withdrawal times. Also colonoscopy withdrawal times are inherently much faster than recommended and highlights the importance of regular adenoma detection rate and withdrawal time auditing.
研究表明，在接受结直肠癌筛查的患者中，结肠镜检查退镜时间至少6分钟与腺瘤检出率增加相关。
我们旨在通过一项在克赖斯特彻奇医院（新西兰克赖斯特彻奇）进行的盲法研究，确定结肠镜检查的退镜时间和息肉检出率，以确定两者之间是否存在关联。
在一家三级医院进行结肠镜检查的所有16位顾问内镜医师，在2007年4月11日至2007年5月19日期间连续进行的208例检查中，对他们从盲肠的退镜时间进行了前瞻性计时。收集了以下数据：检查指征、最终诊断、息肉切除率、所进行的检查以及退镜时间。对所有患者的组织学结果进行了复查。
111例（53%）结肠镜检查是为了症状评估，97例（47%）是为了监测。内镜医师的退镜时间存在显著异质性（p<0.001）。所有结肠镜检查中有65例（31.3%）诊断出息肉。在筛查结肠镜检查中，38例（39.1%）发现了息肉，其中14例为腺瘤（腺瘤检出率为14%）。未发现息肉时，结肠镜检查的中位退镜时间为3分16秒（范围为5秒至11分50秒）。发现息肉时，结肠镜检查的中位时间为8分31秒，其中包括操作所用时间（范围为2分7秒至35分40秒），p<0.001。
本研究证实，退镜时间较慢的内镜医师发现的腺瘤更多。此外，结肠镜检查的退镜时间本质上比推荐时间快得多，这凸显了定期进行腺瘤检出率和退镜时间审核的重要性。
