Kim Yong Gil, Kim Kyung-Jo, Yang Dong-Hoon, Ye Byong Duk, Byeon Jeong-Sik, Myung Seung-Jae, Yang Suk-Kyun, Kim Jin-Ho
Department of Internal Medicine, Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University Gumi Hospital, Soonchunhyang University College of Medicine , Gumi , Korea.
Scand J Gastroenterol. 2014 Aug;49(8):1007-13. doi: 10.3109/00365521.2013.856465. Epub 2014 Jun 24.
Few data are available on the influence of a colonoscope length for trainees, which could affect both the duration of training and colonoscopy quality. We conducted this study to validate which scope needs more duration for training to reach technical competence and to shows better quality indicators during diagnostic colonoscopy.
We conducted a prospective randomly assigned study from April 2010 to February 2011 at Asan Medical Center. Among the 1329 patients enrolled, 1200 colonoscopies were analyzed. We compared cecal intubation rate, adenoma detection rate, cecal intubation time (<20 min), and withdrawal time between the trainees using the intermediate-length colonoscope and those using long-length colonoscope.
Trainees who used the long-length colonoscope showed a higher overall cecal intubation rate (88.2% vs. 81.0%, p = 0.001) and adenoma detection rate (49.7% vs. 34.2%, p < 0.001) than those using the intermediate-length colonoscope. The successful cecal intubation rate improved significantly and reached the requisite standard of competence (>90%) after 90 procedures in the long-length colonoscope group. However, the trainees using the intermediate-length colonoscope reached the requisite standard of competence after 150 procedures. Logistic regression analysis revealed that prolonged cecal intubation was associated with the use of the intermediate-length colonoscope, poor colon preparation, a small number of esophagastroduodenoscopy or sigmoidoscopy procedures conducted, and pain during procedures.
During the same training period, use of the long-length colonoscope in trainee was better in terms of reaching competency and quality indicators, and was less painful for the patients during colonoscopic procedures.
关于结肠镜长度对受训者的影响，目前可用数据较少，而这可能会影响培训时长和结肠镜检查质量。我们开展本研究以验证哪种结肠镜在培训中需要更长时间才能达到技术能力要求，并在诊断性结肠镜检查期间显示出更好的质量指标。
2010年4月至2011年2月，我们在峨山医学中心进行了一项前瞻性随机分配研究。在纳入的1329例患者中，对1200例结肠镜检查进行了分析。我们比较了使用中等长度结肠镜的受训者和使用长长度结肠镜的受训者之间的盲肠插管率、腺瘤检出率、盲肠插管时间（<20分钟）和退镜时间。
与使用中等长度结肠镜的受训者相比，使用长长度结肠镜的受训者总体盲肠插管率更高（88.2%对81.0%，p = 0.001），腺瘤检出率更高（49.7%对34.2%，p < 0.001）。长长度结肠镜组在90例操作后，成功盲肠插管率显著提高并达到了必要的能力标准（>90%）。然而，使用中等长度结肠镜的受训者在150例操作后达到了必要的能力标准。逻辑回归分析显示，盲肠插管时间延长与使用中等长度结肠镜、结肠准备不佳、进行的食管胃十二指肠镜检查或乙状结肠镜检查操作数量少以及操作过程中的疼痛有关。
在相同的培训期间，受训者使用长长度结肠镜在达到能力要求和质量指标方面表现更好，并且在结肠镜检查过程中对患者造成的疼痛更小。
