结肠镜检查时息肉定位的准确性。
Accuracy of polyp localization at colonoscopy.
作者信息
O'Connor Sam A, Hewett David G, Watson Marcus O, Kendall Bradley J, Hourigan Luke F, Holtmann Gerald
机构信息
Department of Gastroenterology and Hepatology, Princess Alexandra Hospital;; School of Medicine, The University of Queensland;
School of Medicine, The University of Queensland;; Department of Gastroenterology, Queen Elizabeth II Jubilee Hospital;
出版信息
Endosc Int Open. 2016 Jun;4(6):E642-6. doi: 10.1055/s-0042-105864. Epub 2016 May 19.
BACKGROUND AND STUDY AIMS
Accurate documentation of lesion localization at the time of colonoscopic polypectomy is important for future surveillance, management of complications such as delayed bleeding, and for guiding surgical resection. We aimed to assess the accuracy of endoscopic localization of polyps during colonoscopy and examine variables that may influence this accuracy.
PATIENTS AND METHODS
We conducted a prospective observational study in consecutive patients presenting for elective, outpatient colonoscopy. All procedures were performed by Australian certified colonoscopists. The endoscopic location of each polyp was reported by the colonoscopist at the time of resection and prospectively recorded. Magnetic endoscope imaging was used to determine polyp location, and colonoscopists were blinded to this image. Three experienced colonoscopists, blinded to the endoscopist's assessment of polyp location, independently scored the magnetic endoscope images to obtain a reference standard for polyp location (Cronbach alpha 0.98). The accuracy of colonoscopist polyp localization using this reference standard was assessed, and colonoscopist, procedural and patient variables affecting accuracy were evaluated.
RESULTS
A total of 155 patients were enrolled and 282 polyps were resected in 95 patients by 14 colonoscopists. The overall accuracy of polyp localization was 85 % (95 % confidence interval, CI; 60 - 96 %). Accuracy varied significantly (P < 0.001) by colonic segment: caecum 100 %, ascending 77 % (CI;65 - 90), transverse 84 % (CI;75 - 92), descending 56 % (CI;32 - 81), sigmoid 88 % (CI;79 - 97), rectum 96 % (CI;90 - 101). There were significant differences in accuracy between colonoscopists (P < 0.001), and colonoscopist experience was a significant independent predictor of accuracy (OR 3.5, P = 0.028) after adjustment for patient and procedural variables.
CONCLUSIONS
Accuracy of localization of polyps is imprecise and affected by position within the colon and colonoscopist, including their level of experience. Magnetic endoscope imaging may improve the localization of lesions during colonoscopy.
背景与研究目的
在结肠镜息肉切除术中准确记录病变位置对于未来的监测、诸如延迟出血等并发症的处理以及指导手术切除都很重要。我们旨在评估结肠镜检查期间息肉内镜定位的准确性，并研究可能影响该准确性的变量。
患者与方法
我们对连续前来接受择期门诊结肠镜检查的患者进行了一项前瞻性观察研究。所有操作均由澳大利亚认证的结肠镜检查医师进行。每位息肉切除时的内镜位置由结肠镜检查医师报告并前瞻性记录。使用磁性内镜成像确定息肉位置，结肠镜检查医师对该图像不知情。三位经验丰富的结肠镜检查医师在不知道内镜检查医师对息肉位置评估的情况下，独立对磁性内镜图像进行评分，以获得息肉位置的参考标准（Cronbach α系数为0.98）。使用该参考标准评估结肠镜检查医师息肉定位的准确性，并评估影响准确性的结肠镜检查医师、操作和患者变量。
结果
共纳入155例患者，14位结肠镜检查医师为95例患者切除了282个息肉。息肉定位的总体准确率为85%（95%置信区间，CI；60 - 96%）。不同结肠段的准确率差异显著（P < 0.001）：盲肠为100%，升结肠为77%（CI；65 - 90），横结肠为84%（CI；75 - 92），降结肠为56%（CI；32 - 81），乙状结肠为88%（CI；79 - 97），直肠为96%（CI；90 - 101）。结肠镜检查医师之间的准确率存在显著差异（P < 0.001），在对患者和操作变量进行调整后，结肠镜检查医师的经验是准确率的一个显著独立预测因素（OR 3.5，P = 0.028）。
结论
息肉定位的准确性不精确，受结肠内位置和结肠镜检查医师（包括其经验水平）的影响。磁性内镜成像可能会改善结肠镜检查期间病变的定位。
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