Am J Gastroenterol. 2013 Jun;108(6):1000-2. doi: 10.1038/ajg.2013.99.
Interval (missed) cancers and lower-than-expected mortality reduction of proximal colon cancers after screening colonoscopy drew attention to quality indicators. Small proximal polyps (prone to be advanced neoplasms) missed by colonoscopy are possible contributing factors. In this issue of AJG, the subject of polyp detection rates (PDRs) and adenoma detection rates (ADRs) in the proximal and distal colon is discussed by one group of investigators to address the issue of monitoring performance and to achieve improvement. The authors observed that these two parameters correlated well in segments proximal to the splenic flexure, but not in the left colon. They suggested that caution should be exercised when using PDR as a surrogate for ADR if data from the rectum and sigmoid were included. Avoidance of missed lesions at the time of colonoscopy may require new adjunct measures to enhance ADR. The impact of new adjunct measures on ADR is mixed. In contrast to water immersion, water exchange during insertion has consistently increased ADR during withdrawal inspection. Water exchange may be a suitable alternative platform to replace insertion by air insufflation in the evaluation of new adjunct measures of quality improvement to increase ADR. Payment reforms may be necessary to bring about inclusion of ADR reporting for monitoring of quality performance.
间期（漏检）癌症和结肠镜筛查后近端结肠癌死亡率降低低于预期，这引起了人们对质量指标的关注。结肠镜漏检的小的近端息肉（易发生高级别肿瘤）可能是促成因素。在本期 AJG 中，一组研究人员讨论了近端和远端结肠的息肉检出率（PDR）和腺瘤检出率（ADR），以解决监测性能和实现改进的问题。作者观察到，在脾曲近端的节段，这两个参数相关性较好，但在左半结肠则不然。他们建议，如果包括直肠和乙状结肠的数据，则应谨慎使用 PDR 作为 ADR 的替代指标。为了避免结肠镜检查时漏诊病变，可能需要新的辅助措施来提高 ADR。新辅助措施对 ADR 的影响是混杂的。与水浸法不同，在退镜检查时进行注水交换始终会增加退镜时的 ADR。水交换可能是一种合适的替代平台，可以替代空气充气插入，用于评估提高 ADR 的新辅助措施的质量改进，以提高 ADR。可能需要支付改革来纳入 ADR 报告，以监测质量绩效。
