Baker Scott L, Miller Roberta A, Creighton Amy, Aguilar Pedro S
Scott L. Baker, MD, FACS, is with Surgical Institute of South Dakota, Sioux Falls. Roberta A. Miller, BSN, RN, CGRN, is Quality Specialist, Grant Medical Center, Columbus, Ohio. Amy Creighton, MS, is Clinical Data Base Informatist, Grant Medical Center, Columbus, Ohio. Pedro S. Aguilar, MD, FACS, FASCRS, is Program Director of the Colorectal Surgery fellowship program, Grant Medical Center, Columbus, Ohio.
Gastroenterol Nurs. 2015 Mar-Apr;38(2):96-9. doi: 10.1097/SGA.0000000000000094.
In 2002, a U.S. Multi-Society Task Force on colorectal cancer recommended a 6-minute or more withdrawal time as an indicator of a quality colonoscopy. In 2006, found a correlation between longer withdrawal time and an increased rate in the detection of adenomas. In January 2008, the endoscopy department at our institution adopted the Multi-Society Task Force recommendation. The aim of our study was to evaluate the effect of a minimal 6-minute withdrawal time policy at our institution on polyp detection rate. All colonoscopies performed for screening indications from April 2007 to September 2008 were reviewed retrospectively. Group I (pre-policy) was compared with Group II (post-policy). Data collected included age, gender, indication, polyp detection rate, size, and withdrawal time. Unpaired t tests evaluated pre- and postprocedure results. Fisher's exact tests were used to compare detection rates between withdrawal time less than 6 minutes and more than 6 minutes. Mann-Whitney U Tests were performed to analyze the significance between the number of polyps detected for withdrawal time less than 6 minutes versus more than 6 minutes. A total of 1,342 colonoscopies were available for analysis in Group I and 1,316 in Group II. Polyp detection rate was 46.6% in Group I versus 48.2% in Group II (p = .39), a non-statistically significant difference; however, there was a trend toward identifying small- and medium-sized polyps in Group II. Small polyps can carry a risk of severe dysplasia (). Data were then analyzed for withdrawal time. The polyp detection rate was 20.9 in procedures that took less than 6 minutes versus 48.3 in those that took more than 6 minutes (p ≤ .01). In this study, a 6-minute or more withdrawal time increased the polyp detection rate by 133% for all polyp sizes, especially small and medium. Small polyps (5 mm or less) should be removed and not ignored. A 6-minute or more withdrawal time should be mandatory in those patients without a previous colon resection.
2002年，美国结直肠癌多学会特别工作组建议将6分钟或更长的退镜时间作为高质量结肠镜检查的一个指标。2006年，发现退镜时间延长与腺瘤检出率增加之间存在相关性。2008年1月，我们机构的内镜科采用了多学会特别工作组的建议。我们研究的目的是评估在我们机构实施至少6分钟退镜时间政策对息肉检出率的影响。对2007年4月至2008年9月期间因筛查指征进行的所有结肠镜检查进行回顾性分析。将第一组（政策实施前）与第二组（政策实施后）进行比较。收集的数据包括年龄、性别、指征、息肉检出率、大小和退镜时间。采用非配对t检验评估术前和术后结果。采用Fisher精确检验比较退镜时间少于6分钟和多于6分钟时的检出率。采用Mann-Whitney U检验分析退镜时间少于6分钟与多于6分钟时息肉检出数量之间的差异。第一组共有1342例结肠镜检查可供分析，第二组有1316例。第一组的息肉检出率为46.6%，第二组为48.2%（p = 0.39），差异无统计学意义；然而，第二组有发现中小息肉的趋势。小息肉可能有重度发育异常的风险（）。然后对退镜时间的数据进行分析。退镜时间少于6分钟的检查中息肉检出率为20.9，而退镜时间多于6分钟的检查中息肉检出率为48.3（p≤0.01）。在本研究中，6分钟或更长的退镜时间使所有息肉大小的息肉检出率提高了133%，尤其是中小息肉。小息肉（5毫米或更小）应予以切除，不可忽视。对于既往未行结肠切除术的患者，应强制要求退镜时间为6分钟或更长。
