Loffeld R J L F, Liberov B, Dekkers P E P
Department of Internal Medicine and Gastroenterology, Zaans Medisch Centrum, Zaandam, Netherlands,
Int J Colorectal Dis. 2015 Jul;30(7):927-32. doi: 10.1007/s00384-015-2181-2. Epub 2015 Mar 31.
The adenoma detection rate (ADR), a marker of endoscopic quality, is confounded by selection bias. It is not known what the ADR is in normal daily practice.
To study the polyp detection rate (PDR) in different endoscopists in the course of years.
All consecutive endoscopies of the colon done in 11 years were included. Endoscopies in the regular surveillance programme after polyp removal and after surgery because of colorectal cancer or diverticular disease were scored separately. The number of yearly procedures per endoscopist and presence of polyps, anastomoses, surveillance and cancer were noted.
In the period of 11 years, 14,908 consecutive endoscopies of colon and rectum were done by four endoscopists. Two endoscopists had a significantly lower PDR than the other two (p < 0.001), these two had the longest careers in endoscopy. The two younger endoscopists did significantly less often procedures in patients with anastomoses and because of surveillance (p < 0.001, respectively). One endoscopist detected significantly less colorectal cancers than the other three endoscopists (p < 0.001).
This study presents the PDR in normal routine daily endoscopy practice. It can be concluded that the PDR, implicating the ADR, in unselected patients can be lower in individual endoscopists than recommended in the literature. This highly depends on the case-mix of patients presented for endoscopy. This result debates the use of the ADR as quality indicator for individual endoscopists.
腺瘤检出率（ADR）作为内镜检查质量的一个指标，受到选择偏倚的影响。在日常常规实践中，ADR究竟如何尚不清楚。
研究多年来不同内镜医师的息肉检出率（PDR）。
纳入11年间所有连续进行的结肠镜检查。息肉切除术后、因结直肠癌或憩室病手术后定期监测计划中的内镜检查分别计分。记录每位内镜医师每年的操作次数以及息肉、吻合口、监测情况和癌症的存在情况。
在11年期间，4位内镜医师连续进行了14,908例结肠和直肠内镜检查。两位内镜医师的PDR显著低于另外两位（p < 0.001），这两位在内镜检查领域的从业时间最长。两位年轻的内镜医师在有吻合口的患者中以及因监测而进行操作的频率显著更低（分别为p < 0.001）。一位内镜医师检测到的结直肠癌明显少于其他三位内镜医师（p < 0.001）。
本研究展示了日常常规内镜检查实践中的PDR。可以得出结论，在未经过挑选的患者中，个别内镜医师的PDR（与ADR相关）可能低于文献中推荐的水平。这在很大程度上取决于接受内镜检查患者的病例组合情况。这一结果引发了对将ADR用作个别内镜医师质量指标的争议。
