高清结肠镜检查可提高腺瘤检出率。
High-definition colonoscopy increases adenoma detection rate.
作者信息
Jrebi Nezar Y, Hefty Matthew, Jalouta Tarek, Ogilvie James, Davis Alan T, Asgeirsson Theodor, Luchtefeld Martin
机构信息
Ferguson Clinic, Grand Rapids Medical Education Partners Research Department, Michigan State University, Grand Rapids, MI, USA.
Department of Surgery, West Virginia University-Ruby Memorial Hospital, 1 Medical Center Drive, PO BOX 9238, Morgantown, WV, 26506, USA.
出版信息
Surg Endosc. 2017 Jan;31(1):78-84. doi: 10.1007/s00464-016-4986-7. Epub 2016 Jun 10.
BACKGROUND
The adenoma detection rate (ADR) is a quality indicator for colonoscopy. High-definition (HD) imaging has been reported to increase polyp detection rates.
OBJECTIVE
The primary objective of this study was to compare polyp detection rate (PDR) and adenoma detection rate (ADR) before and after the implementation of HD colonoscopy.
METHODS
A retrospective chart review was performed on patients aged 48-55 years old, who underwent first-time screening colonoscopy. The first group underwent standard-definition (SD) colonoscopy in the first 6 months of 2011. The second group underwent screening with HD colonoscopy during the first 6 months of 2012. We compared age, gender, PDR, ADR, and average sizes of adenomatous polyps between gastroenterologist and colorectal surgeon and among physicians themselves. Statistical analysis was performed with Fischer's exact test and Pearson Chi-square.
RESULTS
A total of 1268 patients were involved in the study (634 in each group). PDR (35.6 vs. 48.2 %, p < 0.001) and ADR (22.2 vs. 30.4 %, p = 0.02) were higher in the HD group. The average size of an adenomatous polyp was the same in the two groups (0.58 vs. 0.57, p = 0.69). However, this difference was not seen among colorectal surgeons PDR (35.7 vs. 37 %, p = 0.789), ADR (22.9 vs. 24.5 % p = 0.513), but clearly seen among gastroenterologist, PDR (35.6 vs. 53.1 % p < 0.001) and ADR (21.9 vs. 32.9 % p < 0.001). When polyps were categorized into size groups, there was no difference in ADR between the two timeframes (<5 mm in size (41.5 vs. 35.4 %), 5-10 mm (49.3 vs. 60.1 %) and >10 mm (9.2 vs. 4.5 %), p = 0.07). Polyps were most commonly seen in the sigmoid colon (26.1 vs. 24.7 %). There was no difference in the rate of synchronous polyp detection between modalities (25.6 vs. 29 %, p = 0.51). Withdrawal time was the same in both procedure (9.2 vs. 8.5 min, p = 0.10).
CONCLUSION
Screening colonoscopy with high-definition technology significantly improved both PDR and ADR. In addition, high-definition colonoscopy may be particularly useful and advantageous among less experienced endoscopists in various community settings. However, there needs to be application to specific patient populations in future studies to assess for any statistical differences between standard- and high-definition modalities to determine clinical utility.
背景
腺瘤检出率（ADR）是结肠镜检查的一项质量指标。据报道，高清（HD）成像可提高息肉检出率。
目的
本研究的主要目的是比较高清结肠镜检查实施前后的息肉检出率（PDR）和腺瘤检出率（ADR）。
方法
对年龄在48 - 55岁之间接受首次筛查结肠镜检查的患者进行回顾性病历审查。第一组在2011年的前6个月接受标准清晰度（SD）结肠镜检查。第二组在2012年的前6个月接受高清结肠镜检查筛查。我们比较了胃肠病学家和结直肠外科医生之间以及医生自身之间的年龄、性别、PDR、ADR和腺瘤性息肉的平均大小。采用Fisher精确检验和Pearson卡方检验进行统计分析。
结果
共有1268例患者参与研究（每组634例）。高清组的PDR（35.6%对48.2%，p < 0.001）和ADR（22.2%对30.4%，p = 0.02）更高。两组腺瘤性息肉的平均大小相同（0.58对0.57，p = 0.69）。然而，在结直肠外科医生中未观察到这种差异，PDR（35.7%对37%，p = 0.789），ADR（22.9%对24.5%，p = 0.513），但在胃肠病学家中差异明显，PDR（35.6%对53.1%，p < 0.001）和ADR（21.9%对32.9%，p < 0.001）。当将息肉按大小分组时，两个时间段的ADR没有差异（<5mm大小（41.5%对35.4%），5 - 10mm（49.3%对60.1%）和>10mm（9.2%对4.5%），p = 0.07）。息肉最常见于乙状结肠（26.1%对24.7%）。两种检查方式的同步息肉检出率没有差异（25.6%对29%，p = 0.51）。两种检查的退镜时间相同（9.2分钟对8.5分钟，p = 0.10）。
结论
采用高清技术的筛查结肠镜检查显著提高了PDR和ADR。此外，在各种社区环境中，高清结肠镜检查对于经验较少的内镜医师可能特别有用且具有优势。然而，未来研究需要将其应用于特定患者群体，以评估标准清晰度和高清检查方式之间的任何统计学差异，从而确定临床实用性。
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