Department of Medicine, Telemark Hospital, Skien, Norway.
Institute of Health and Society, University of Oslo, Oslo, Norway; Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway; Department of Medicine, Sørlandet Hospital, Kristiansand, Norway.
United European Gastroenterol J. 2016 Feb;4(1):110-20. doi: 10.1177/2050640615570147. Epub 2015 Feb 5.
There is considerable variation in the quality of colonoscopy performance. The Norwegian quality assurance programme Gastronet registers outpatient colonoscopies performed in Norwegian endoscopy centres. The aim of Gastronet is long-term improvement of endoscopist and centre performance by annual feedback of performance data.
The objective of this article is to perform an analysis of trends of quality indicators for colonoscopy in Gastronet.
This prospective cohort study included 73,522 outpatient colonoscopies from 73 endoscopists at 25 endoscopy centres from 2003 to 2012. We used multivariate logistic regression with adjustment for relevant variables to determine annual trends of three performance indicators: caecum intubation rate, pain during the procedure, and detection rate of polyps ≥5 mm.
The proportion of severely painful colonoscopies decreased from 14.8% to 9.2% (relative risk reduction of 38%; OR = 0.92 per year in Gastronet; 95% CI 0.86-1.00; p = 0.045). Caecal intubation (OR = 0.99; 95% CI 0.94-1.04; p = 0.6) and polyp detection (OR = 1.03; 95% CI 0.99-1.07; p = 0.15) remained unchanged during the study period.
Pain at colonoscopy showed a significant decrease during years of Gastronet participation while caecal intubation and polyp detection remained unchanged - independent of the use of sedation and/or analgesics and level of endoscopist experience. This may be due to the Gastronet audit, but effects of improved endoscopy technology cannot be excluded.
结肠镜检查的质量存在很大差异。挪威质量保证计划 Gastronet 登记了在挪威内镜中心进行的门诊结肠镜检查。Gastronet 的目的是通过每年反馈绩效数据，长期提高内镜医师和中心的绩效。
本文旨在分析 Gastronet 中结肠镜检查质量指标的趋势。
这项前瞻性队列研究纳入了 2003 年至 2012 年间，来自 25 个内镜中心的 73 名内镜医师的 73522 例门诊结肠镜检查。我们使用多变量逻辑回归，结合相关变量调整，确定了三个绩效指标的年度趋势：盲肠插管率、检查过程中的疼痛程度和 5mm 以上息肉的检出率。
严重疼痛结肠镜检查的比例从 14.8%降至 9.2%（相对风险降低 38%；Gastronet 中每年的 OR 值为 0.92；95%CI 0.86-1.00；p=0.045）。盲肠插管（OR=0.99；95%CI 0.94-1.04；p=0.6）和息肉检出率（OR=1.03；95%CI 0.99-1.07；p=0.15）在研究期间保持不变。
在 Gastronet 参与期间，结肠镜检查疼痛显著下降，而盲肠插管和息肉检出率保持不变-独立于镇静和/或镇痛的使用以及内镜医师经验水平。这可能是 Gastronet 审核的结果，但不能排除内镜技术改进的影响。
