良好优于优秀：肠道准备质量与腺瘤检出率。

Good is better than excellent: bowel preparation quality and adenoma detection rates.

作者信息

Calderwood Audrey H, Thompson Katherine D, Schroy Paul C, Lieberman David A, Jacobson Brian C

机构信息

Section of Gastroenterology, Boston Medical Center, Boston, Massachusetts, USA.

Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA.

出版信息

Gastrointest Endosc. 2015 Mar;81(3):691-699.e1. doi: 10.1016/j.gie.2014.10.032.

DOI:10.1016/j.gie.2014.10.032

PMID:25708756

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4339796/

Abstract

BACKGROUND

Inadequate bowel cleansing is associated with missed lesions, yet whether polyp and adenoma detection rates (PDR, ADR) increase at the highest levels of bowel cleanliness is unknown.

OBJECTIVE

To evaluate the association between bowel preparation quality by using the Boston Bowel Preparation Scale (BBPS) and PDR and ADR among colonoscopies with adequate preparation.

DESIGN

Cross-sectional analysis.

SETTING

Boston Medical Center (BMC) and the Clinical Outcomes Research Initiative (CORI).

PATIENTS

Average-risk ambulatory patients attending screening colonoscopy with adequate bowel preparation defined as BBPS score ≥6.

INTERVENTIONS

Colonoscopy.

MAIN OUTCOME MEASUREMENTS

PDR and ADR stratified by BBPS score.

RESULTS

Among the 3713 colonoscopies at BMC performed by 19 endoscopists, the PDR, ADR, and advanced ADR were 49.8%, 37.7%, and 6.0%, respectively. Among the 5532 colonoscopies in CORI performed by 85 endoscopists at 41 different sites, the PDR was 44.5%, and the PDR for polyps >9 mm (surrogate for advanced ADR) was 6.2%. The PDR associated with total BBPS scores of 6, 7, and 8 were higher than those associated with a BBPS score of 9 at BMC (BBPS 6, 51%; BBPS 7, 53%; BBPS 8, 52% vs BBPS 9, 46%; P = .002) and CORI (BBPS 6, 51%; BBPS 7, 48%; BBPS 8, 45% vs BBPS 9, 40%; P < .0001). This trend persisted after we adjusted for age, sex, and race and/or ethnicity and was observed for ADR and advanced ADR. PDR was higher among good compared with excellent preparations at BMC (odds ratio [OR] 1.3; 95% confidence interval [CI], 1.0-1.5) and CORI (OR 4.7; 95% CI, 3.1-7.1).

LIMITATIONS

Retrospective study.

CONCLUSION

The PDR and ADR decreased at the highest levels of bowel cleanliness. Endoscopists finding a pristine bowel preparation should avoid a sense of overconfidence for polyp detection during the inspection phase of screening colonoscopy and still perform a careful evaluation for polyps. Furthermore, endoscopists expending additional effort to maximize cleansing of the bowel should never sacrifice on their inspection technique or inspection time.

摘要

背景

肠道准备不充分与病变漏诊相关，但在肠道清洁程度最高时息肉和腺瘤检出率（PDR、ADR）是否会增加尚不清楚。

目的

通过使用波士顿肠道准备量表（BBPS）评估肠道准备质量与充分准备的结肠镜检查中PDR和ADR之间的关联。

设计

横断面分析。

地点

波士顿医疗中心（BMC）和临床结果研究倡议组织（CORI）。

患者

接受筛查结肠镜检查的平均风险门诊患者，肠道准备充分定义为BBPS评分≥6分。

干预措施

结肠镜检查。

主要观察指标

按BBPS评分分层的PDR和ADR。

结果

在由19名内镜医师在BMC进行的3713例结肠镜检查中，PDR、ADR和高级ADR分别为49.8%、37.7%和6.0%。在由41个不同地点的85名内镜医师在CORI进行的5532例结肠镜检查中，PDR为44.5%，直径>9 mm息肉（高级ADR替代指标）的PDR为6.2%。在BMC（BBPS 6分，51%；BBPS 7分，53%；BBPS 8分，52% 对比BBPS 9分，46%；P = 0.002）和CORI（BBPS 6分，51%；BBPS 7分，48%；BBPS 8分，45% 对比BBPS 9分，40%；P < 0.0001），与总BBPS评分为6、7和8分相关的PDR高于与BBPS评分为9分相关的PDR。在调整年龄、性别、种族和/或族裔后，这一趋势仍然存在，ADR和高级ADR也观察到了这一趋势。在BMC（优势比[OR] 1.3；95%置信区间[CI]，1.0 - 1.5）和CORI（OR 4.7；95% CI，3.1 - 7.1），良好准备与优秀准备相比，PDR更高。