Division of Gastroenterology and Hepatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair, Suite 1400, Chicago, IL 60611, USA.
Dig Dis Sci. 2013 Jul;58(7):1849-55. doi: 10.1007/s10620-013-2605-1. Epub 2013 Mar 2.
There are limited data on recommendations and adherence to complete colon evaluation (CCE) after incomplete colonoscopy (IC).
Our objectives were to (1) identify recommendations and adherence to recommendations after IC, (2) determine the diagnostic yield of CCE after IC, and (3) determine the effect of an IC referral program on recommendations for CCE.
We conducted a retrospective review of IC procedures at a teaching hospital over two time periods (January 1 to May 1 2004 and July 1 to November 1 2010). A referral process for repeat colonoscopy after IC was instituted in April 2009. Outcomes included (1) recommendations (2) adherence, and (3) yield of CCE after IC.
A total of 222 patients underwent at least one IC (overall rate of 2.5 %). In 120 patients (54.1 %), CCE was recommended within 1 year; the rate did not change from 2004 to 2010. Patients with IC due to poor preparation were more likely to have specific CCE recommendations (85.5 vs. 72.2 %, P = 0.03) and recommendations of endoscopic follow-up (76.3 vs. 10.4 %, P < 0.0001) than those with IC due to difficult anatomy. When IC was due to difficult colonoscopy, there was increase in endoscopic follow-up recommended (16.3 vs. 2.8 %, P = 0.01) in 2010 compared to 2004. Adherence to recommendations was similar regardless of modality recommended, inpatient/outpatient status, polyps on initial exam, or extent of initial exam. Polyp detection rate was greater utilizing colonoscopy than barium enema (34.3 vs. 3.6 %, P < 0.0001).
There is a lack of consensus in management strategies for patients after IC. Implementation of a referral program has had minimal impact on provider recommendations.
关于不完全结肠镜检查（IC）后完整结肠评估（CCE）的建议和依从性的数据有限。
我们的目的是：（1）确定 IC 后的建议和建议的依从性；（2）确定 IC 后 CCE 的诊断效果；（3）确定 IC 转诊计划对 CCE 建议的影响。
我们对一家教学医院在两个时间段（2004 年 1 月 1 日至 5 月 1 日和 2010 年 7 月 1 日至 11 月 1 日）进行了 IC 程序的回顾性分析。2009 年 4 月建立了 IC 后重复结肠镜检查的转诊程序。结果包括（1）建议；（2）依从性；（3）IC 后 CCE 的产量。
共有 222 例患者至少进行了一次 IC（总体发生率为 2.5%）。在 120 例患者（54.1%）中，在 1 年内推荐了 CCE；该比率在 2004 年至 2010 年期间没有变化。由于准备不佳而进行 IC 的患者更有可能获得特定的 CCE 建议（85.5%比 72.2%，P=0.03）和内镜随访建议（76.3%比 10.4%，P<0.0001）比因解剖困难而进行 IC 的患者。当 IC 因结肠镜检查困难时，与 2004 年相比，2010 年推荐增加了内镜随访（16.3%比 2.8%，P=0.01）。无论推荐的方式、住院/门诊状态、初始检查中的息肉或初始检查的范围如何，建议的依从性相似。与钡剂灌肠相比，结肠镜检查的息肉检出率更高（34.3%比 3.6%，P<0.0001）。
IC 后患者的管理策略缺乏共识。转诊计划的实施对提供者的建议影响很小。
