Lee Thomas J W, Rees Colin J, Blanks Roger G, Moss Sue M, Nickerson Claire, Wright Karen C, James Peter W, McNally Richard J Q, Patnick Julietta, Rutter Matthew D
Tees Bowel Cancer Screening Centre, University Hospital of North Tees, Stockton-on-Tees, UK.
South of Tyne Bowel Cancer Screening Centre, South Tyneside District Hospital, South Shields, UK.
Endoscopy. 2014 Mar;46(3):203-11. doi: 10.1055/s-0033-1358831. Epub 2014 Jan 28.
Adenoma detection is a key objective of colonoscopy, particularly in the context of colorectal cancer screening. The aim of this observational study was to identify the technical colonoscopy factors associated with adenoma detection.
The study analyzed data from the English Bowel Cancer Screening Programme. The indication for all colonoscopies was a positive fecal occult blood test. The relationships between the following colonoscopy factors and adenoma detection (one or more adenomas, advanced adenomas, right-sided adenomas, and total number of adenomas) were examined in multivariable analyses: bowel preparation quality, cecal intubation, withdrawal time, rectal retroversion, colonoscopist experience, antispasmodic use, sedation use, and start time of procedure. The following patient factors were controlled for: age, sex, body mass index, smoking, alcohol, deprivation, and geographical location.
A total of 31088 colonoscopies were analyzed. The following technical factors increased the relative risk of adenoma detection (P < 0.001 in multivariable analysis unless otherwise stated): cecal intubation, increased withdrawal time, higher quality bowel preparation, intravenous antispasmodic use, earlier procedure start time within a session (P = 0.018), and greater colonoscopist experience. Detection of advanced and right-sided adenomas also increased with these factors. Adenoma detection did not differ between sedated and unsedated colonoscopy (P = 0.143).
This study demonstrated important associations between colonoscopy practice and adenoma detection. Use of intravenous antispasmodic was associated with increased adenoma detection. The effect of the start time of colonoscopy suggests that endoscopist fatigue may have a deleterious impact on adenoma detection.
腺瘤检测是结肠镜检查的关键目标，尤其是在结直肠癌筛查的背景下。本观察性研究的目的是确定与腺瘤检测相关的结肠镜检查技术因素。
该研究分析了来自英国肠癌筛查项目的数据。所有结肠镜检查的指征均为粪便潜血试验阳性。在多变量分析中，研究了以下结肠镜检查因素与腺瘤检测（一个或多个腺瘤、高级别腺瘤、右侧腺瘤以及腺瘤总数）之间的关系：肠道准备质量、盲肠插管、退镜时间、直肠反转、结肠镜检查医师经验、抗痉挛药物使用、镇静药物使用以及检查开始时间。对以下患者因素进行了控制：年龄、性别、体重指数、吸烟、饮酒、贫困程度以及地理位置。
共分析了31088例结肠镜检查。以下技术因素增加了腺瘤检测的相对风险（多变量分析中P<0.001，另有说明的除外）：盲肠插管、退镜时间增加、更高质量的肠道准备、静脉使用抗痉挛药物、检查时段内较早的检查开始时间（P=0.018）以及结肠镜检查医师经验更丰富。这些因素也增加了高级别和右侧腺瘤的检测率。镇静和非镇静结肠镜检查的腺瘤检测率无差异（P=0.143）。
本研究表明结肠镜检查操作与腺瘤检测之间存在重要关联。静脉使用抗痉挛药物与腺瘤检测率增加有关。结肠镜检查开始时间的影响表明内镜医师疲劳可能对腺瘤检测产生有害影响。
