Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, 687 Pine Avenue West, V Building, Room V2.15, Montreal, QC H3A 1A1, Canada.
BMC Gastroenterol. 2013 May 3;13:78. doi: 10.1186/1471-230X-13-78.
Some studies have shown that endoscopist specialty is associated with colorectal cancers missed by colonoscopy. We sought to examine the relationship between endoscopist specialty and polypectomy rate, a colonoscopy quality indicator. Polypectomy rate is defined as the proportion of colonoscopies that result in the removal of one or more polyps.
A cross-sectional study was conducted of endoscopists and their patients from 7 Montreal and 2 Calgary endoscopy clinics. Eligible patients were aged 50-75 and covered by provincial health insurance. A patient questionnaire assessed family history of colorectal cancer, history of large bowel conditions and symptoms, and previous colonoscopy. The outcome, polypectomy status, was obtained from provincial health administrative databases. For each city, Bayesian hierarchical logistic regression was used to estimate the odds ratio for polypectomy comparing surgeons to gastroenterologists. Model covariates included patient age, sex, family history of colorectal cancer, colonoscopy indication, and previous colonoscopy.
In total, 2,113 and 538 colonoscopies were included from Montreal and Calgary, respectively. Colonoscopies were performed by 38 gastroenterologists and 6 surgeons in Montreal, and by 31 gastroenterologists and 5 surgeons in Calgary. The adjusted odds ratios comparing surgeons to gastroenterologists were 0.48 (95% CI: 0.32-0.71) in Montreal and 0.73 (95% CI: 0.43-1.21) in Calgary.
An association between endoscopist specialty and polypectomy was observed in both cities after adjusting for patient-level covariates. Results from Montreal suggest that surgeons are half as likely as gastroenterologists to remove polyps, while those from Calgary were associated with a wide, non-significant Bayesian credible interval. However, residual confounding from patient-level variables is possible, and further investigation is required.
一些研究表明，内镜医生的专业领域与结肠镜检查中漏诊的结直肠癌有关。我们试图研究内镜医生的专业领域与息肉切除术率之间的关系，息肉切除术率是结肠镜检查质量的一个指标。息肉切除术率定义为导致切除一个或多个息肉的结肠镜检查的比例。
对来自蒙特利尔的 7 家和卡尔加里的 2 家内镜诊所的内镜医生及其患者进行了一项横断面研究。合格的患者年龄在 50-75 岁之间，且受省级医疗保险覆盖。患者问卷评估了结直肠癌家族史、大肠疾病和症状史以及之前的结肠镜检查史。从省级卫生行政数据库中获得了息肉切除术状态的结果。对于每个城市，采用贝叶斯分层逻辑回归估计外科医生与胃肠病学家相比进行息肉切除术的优势比。模型协变量包括患者年龄、性别、结直肠癌家族史、结肠镜检查指征和之前的结肠镜检查。
总共纳入了来自蒙特利尔和卡尔加里的 2113 例和 538 例结肠镜检查。在蒙特利尔，38 名胃肠病学家和 6 名外科医生进行了结肠镜检查，而在卡尔加里，31 名胃肠病学家和 5 名外科医生进行了结肠镜检查。调整了患者水平协变量后，外科医生与胃肠病学家相比，蒙特利尔的优势比为 0.48（95%CI：0.32-0.71），卡尔加里的优势比为 0.73（95%CI：0.43-1.21）。
在调整了患者水平协变量后，在这两个城市都观察到了内镜医生专业领域与息肉切除术之间的关联。来自蒙特利尔的结果表明，外科医生切除息肉的可能性是胃肠病学家的一半，而来自卡尔加里的结果与一个广泛的、无显著意义的贝叶斯可信区间相关。然而，仍可能存在患者水平变量的残余混杂，需要进一步研究。
