Jiang Mengzhu, Sewitch Maida J, Joseph Lawrence, Barkun Alan N
Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
Can J Gastroenterol. 2012 Nov;26(11):791-4. doi: 10.1155/2012/986153.
Polypectomy rate is a surrogate quality indicator for screening colonoscopy. Various methods for identifying screening colonoscopies have been used and it is unclear how different definitions affect the estimated polypectomy rate.
To estimate polypectomy rates and how they vary according to the definition of a screening colonoscopy, using patient- and endoscopist-reported indications.
A cross-sectional analysis of endoscopists and their patients 50 to 75 years of age who underwent colonoscopy was conducted. Based on questionnaire responses, four patient indications were derived: perceived screening; perceived nonscreening; medical history indicating nonscreening; and combination of the three indications. Endoscopist indication was derived from a questionnaire completed immediately after colonoscopy. Polypectomy status was obtained from provincial physician billing records. Polypectomy rates were computed, while accounting for physician and hospital level clustering, using all four patient indications, endoscopist indication, and the agreement between patient and endoscopist indications. The effect of indications on polypectomy rate was estimated adjusting for age, sex and family history of colorectal cancer.
A total of 2134 patients and 45 endoscopists were included. The proportion of colonoscopies classified as screening according to the nine indications ranged from 32.2% to 70.9%. Polypectomy rates ranged between 22.6% and 26.2% for screening colonoscopy, and between 27.1% and 30.8% for nonscreening colonoscopy. Adjusted ORs for indication ranged between 0.74 and 0.94.
Although the proportion of colonoscopies identified as screening varied considerably among the indications, the estimated polypectomy rates were similar.
The findings suggest that the way screening is defined does not greatly affect the estimates of polypectomy rate.
息肉切除率是筛查结肠镜检查的一个替代质量指标。已经使用了各种识别筛查结肠镜检查的方法，目前尚不清楚不同的定义如何影响估计的息肉切除率。
利用患者和内镜医师报告的指征，估计息肉切除率以及它们如何根据筛查结肠镜检查的定义而变化。
对50至75岁接受结肠镜检查的内镜医师及其患者进行横断面分析。根据问卷回复，得出四种患者指征：感知筛查；感知非筛查；表明非筛查的病史；以及这三种指征的组合。内镜医师指征来自结肠镜检查后立即填写的问卷。息肉切除状态从省级医师计费记录中获取。在考虑医师和医院层面聚类的情况下，使用所有四种患者指征、内镜医师指征以及患者和内镜医师指征之间的一致性来计算息肉切除率。在调整年龄、性别和结直肠癌家族史的情况下，估计指征对息肉切除率的影响。
共纳入2134例患者和45名内镜医师。根据这九种指征分类为筛查的结肠镜检查比例在32.2%至70.9%之间。筛查结肠镜检查的息肉切除率在22.6%至26.2%之间，非筛查结肠镜检查的息肉切除率在27.1%至30.8%之间。指征的调整后比值比在0.74至0.94之间。
尽管在各种指征中被确定为筛查的结肠镜检查比例差异很大，但估计的息肉切除率相似。
研究结果表明，筛查的定义方式对息肉切除率的估计影响不大。
