Kozbial Karin, Reinhart Karoline, Heinze Georg, Zwatz Christian, Bannert Christina, Salzl Petra, Waldmann Elisabeth, Britto-Arias Martha, Ferlitsch Arnulf, Trauner Michael, Weiss Werner, Ferlitsch Monika
Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria.
Department of Clinical Biometrics, Medical University of Vienna, Vienna, Austria.
Endoscopy. 2015 Mar;47(3):207-16. doi: 10.1055/s-0034-1390910. Epub 2014 Nov 20.
BACKGROUND AND STUDY AIM: International studies have shown differences in the outcome of screening colonoscopies related to the endoscopist's specialty and setting of colonoscopy. The aim of this study was to investigate the impact of these two factors on quality parameters for screening colonoscopy in a quality-assured screening program. METHODS: Adenoma detection rate (ADR), cecal intubation rate (CIR), polypectomy rate, flat polyp detection rate, carcinoma detection rate, sedation rate, complication rates, and other parameters of 59 901 screening colonoscopies performed by 178 endoscopists were analyzed in relation to specialty (35 gastroenterologists: 10 066 colonoscopies [16.8 %]; 84 nongastroenterologists: 26 271 colonoscopies [43.9 %]; 59 surgeons: 23 564 [39.3 %]), and setting (hospital: 12 580 [21.6 %] colonoscopies; office: 45 781 [78.4 %] colonoscopies). RESULTS: The overall ADR was 20.5 % and the CIR was 95.6 %. The ADR did not show any statistical significance, either in relation to specialty or to setting. A significant difference in the CIR was found between hospital-based and office-based internists (98.5 % vs. 96.8 %, respectively; P = 0.0005; odds ratio [OR] 2.2, 95 % confidence interval [CI] 1.4 - 3.4). Hospital-based internists had a significantly higher flat polyp detection rate (7.5 % vs. 4.1 %; P = 0.02; OR 1.9, 95 %CI 1.1 - 3.2) and a significantly lower carcinoma detection rate (0.4 % vs. 0.6 %; P = 0.03; OR 0.7, 95 %CI 0.5 - 1.0) compared with office-based internists. Complication rates were significantly lower among surgeons than among internists (0.1 % vs. 0.2 %; P = 0.03; OR 0.5, 95 %CI 0.3 - 1.0). CONCLUSION: Endoscopists participating in the Austrian quality assurance program offered high quality screening colonoscopy regardless of their specialty and setting. The implementation of a standardized quality program is therefore a decisive factor in quality improvement of screening colonoscopy.
背景与研究目的:国际研究表明,与内镜医师的专业以及结肠镜检查的地点相关的筛查性结肠镜检查结果存在差异。本研究的目的是在一个质量保证的筛查项目中,调查这两个因素对筛查性结肠镜检查质量参数的影响。 方法:分析了178名内镜医师进行的59901例筛查性结肠镜检查的腺瘤检出率(ADR)、盲肠插管率(CIR)、息肉切除术率、扁平息肉检出率、癌检出率、镇静率、并发症发生率及其他参数,这些参数与专业(35名胃肠病学家:10066例结肠镜检查[16.8%];84名非胃肠病学家:26271例结肠镜检查[43.9%];59名外科医生:23564例[39.3%])以及地点(医院:12580例[21.6%]结肠镜检查;诊所:45781例[78.4%]结肠镜检查)有关。 结果:总体ADR为20.5%,CIR为95.6%。ADR在专业或地点方面均未显示出任何统计学意义。在以医院为基础和以诊所为基础的内科医生之间,CIR存在显著差异(分别为98.5%和96.8%;P = 0.0005;优势比[OR] 2.2,95%置信区间[CI] 1.4 - 3.4)。与以诊所为基础的内科医生相比,以医院为基础的内科医生扁平息肉检出率显著更高(7.5%对4.1%;P = 0.02;OR 1.9,95%CI 1.1 - 3.2),癌检出率显著更低(0.4%对0.6%;P = 0.03;OR 0.7,95%CI 0.5 - 1.0)。外科医生的并发症发生率显著低于内科医生(0.1%对0.2%;P = 0.03;OR 0.5,95%CI 0.3 - 1.0)。 结论:参与奥地利质量保证项目的内镜医师,无论其专业和地点如何,都提供了高质量的筛查性结肠镜检查。因此,实施标准化质量项目是提高筛查性结肠镜检查质量的决定性因素。
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