Gyökeres Tibor, Rusznyák Krisztina, Visnyei Zsolt, Schäfer Eszter, Szamosi Tamás, Banai János
MH Honvédkórház Gasztroenterológia Budapest Podmaniczky.
Orv Hetil. 2012 Jul 22;153(29):1142-52. doi: 10.1556/OH.2012.29408.
The quality of endoscopic examinations substantially determines their value. In developed countries, Continuous Quality Management is used to improve it permanently. In Hungary there is no example for measuring quality in the field of gastrointestinal endoscopy.
The measurement and improvement of quality of endoscopy applying completeness index (cecum intubation rate) during colonoscopy.
The authors defined base values retrospectively from 841 colonoscopy reports, performed in the last quarter of the year, before starting the project. The next two years (3160 colonoscopy in 2009 and 3167 in 2010) every three months they calculated the cecum intubation rate for each endoscopist.
The cecum intubation rate was 81.6% in the base period. When the authors excluded examinations with poor preparations and those with a previously unknown stenosis that prevented the total colonoscopy, the adjusted cecal intubation rate was 90.9%. In the next 2 years, the cecum intubation rate was 84.2% and 85.7% (p = 0.0394), while adjusted cecum intubation rate proved to be 92.3% and 92.6% (p = 0.381 NS) for the whole endoscopy unit. Of the 14 endoscopists only 6 reached an adjusted cecum intubation rate of 90%, but in the second year of the project 10 of them reached this rate and only one endoscopist remained below 87%. The endoscopists performing more than 100 colonoscopies per year had better adjusted cecum intubation rate (base 91.2%; 92.7% and 93.1% during the 2 project years) compared to those with less than 100 colonoscopies per year (base, 86.7%; project period, 85.5 and 89%).
The evaluation and publicity of the cecal intubation rate resulted in an improvement of the quality of colonoscopy. The authors also presented that endoscopists performing more than 100 colonoscopies per year have better endoscopic quality.
内镜检查的质量在很大程度上决定了其价值。在发达国家，持续质量管理被用于持续提高质量。在匈牙利，胃肠内镜领域尚无质量测量的实例。
在结肠镜检查中应用完整性指标（盲肠插管率）来测量和提高内镜检查质量。
作者在项目开始前，回顾性地从该年最后一个季度进行的841份结肠镜检查报告中确定基础值。在接下来的两年（2009年3160例结肠镜检查，2010年3167例）中，他们每三个月计算每位内镜医师的盲肠插管率。
基础期的盲肠插管率为81.6%。当作者排除准备不佳的检查以及那些因先前未知狭窄而无法完成全结肠镜检查的病例后，调整后的盲肠插管率为90.9%。在接下来的两年中，盲肠插管率分别为84.2%和85.7%（p = 0.0394），而整个内镜检查单元的调整后盲肠插管率分别为92.3%和92.6%（p = 0.381，无显著差异）。在14位内镜医师中，只有6位的调整后盲肠插管率达到90%，但在项目的第二年，其中10位达到了该比率，只有一位内镜医师低于87%。每年进行超过100例结肠镜检查的内镜医师，其调整后的盲肠插管率（基础值91.2%；项目的两年中分别为92.7%和93.1%）优于每年进行少于100例结肠镜检查的医师（基础值86.7%；项目期间分别为85.5%和89%）。
盲肠插管率的评估和公布提高了结肠镜检查的质量。作者还指出，每年进行超过100例结肠镜检查的内镜医师内镜质量更好。
