Department of Gastroenterology, G. B. Morgagni Hospital, Forlì, Italy.
Dig Liver Dis. 2013 Dec;45(12):1022-7. doi: 10.1016/j.dld.2013.05.009. Epub 2013 Jun 29.
Suboptimal colonoscopy quality is related to a higher risk of interval cancer. Aim of our study was to explore the variability in detection rate of neoplasia among different endoscopic centres in an unselected population.
Consecutive patients referred for colonoscopy in 28 Italian centres were included. Detection rate for polyp, neoplasia and advanced neoplasia was assessed at both the individual and centre level. Inter-centre variability in detection rate of colorectal lesions was explored after adjusting for patient-related factors at multivariate analysis.
3150 patients were included. Median detection rates for polyp, neoplasia and advanced neoplasia were 35%, 26% and 13%. At multivariate analysis, patient-related factors associated with neoplasia detection were age, sex, alcohol and smoking history. After adjusting for these variables, a statistically significant difference in the observed/expected ratio among different centres was observed (Chi-squared test: p<0.01). Among non-patient-related factors, documentation of withdrawal time was associated with neoplasia detection. However, a statistically significant inter-centre variability also remained after adjusting for this variable.
A wide variability was present in the detection rate of neoplasia and advanced neoplasia at the level of endoscopic centres in an unselected population. The adoption of a centre-related neoplasia detection rate could be suggested as a performance indicator.
结直肠镜检查质量不佳与间隔期癌症风险增加有关。本研究的目的是在未选择人群中探索不同内镜中心间肿瘤检出率的可变性。
纳入 28 家意大利中心连续接受结肠镜检查的患者。在个体和中心水平评估息肉、肿瘤和高级别肿瘤的检出率。在多变量分析中，调整患者相关因素后，探讨结直肠病变检出率的中心间变异性。
纳入 3150 例患者。息肉、肿瘤和高级别肿瘤的中位检出率分别为 35%、26%和 13%。多变量分析显示，与肿瘤检出相关的患者相关因素为年龄、性别、饮酒和吸烟史。在调整这些变量后，观察到不同中心间观察到的/预期比值存在统计学显著差异（卡方检验：p<0.01）。在非患者相关因素中，记录退出时间与肿瘤检出相关。然而，在调整该变量后，仍存在统计学显著的中心间变异性。
在未选择人群中，内镜中心的肿瘤和高级别肿瘤检出率存在很大差异。可以建议采用与中心相关的肿瘤检出率作为绩效指标。
