Anderson Joseph C, Weiss Julia E, Robinson Christina M, Butterly Lynn F
*Department of Veterans Affairs Medical Center, White River Junction, VT †The Geisel School of Medicine at Dartmouth, Hanover ‡Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth §Department of Medicine ∥Section of Gastroenterology, Dartmouth Hitchcock Medical Center, Lebanon, NH.
J Clin Gastroenterol. 2017 Nov/Dec;51(10):e95-e100. doi: 10.1097/MCG.0000000000000795.
To examine screening adenoma detection rates (ADR) and serrated detection rates (SDR) among smokers and obese adults in the New Hampshire Colonoscopy Registry.
ADR, a quality measure for screening colonoscopies, is associated with protection from interval colorectal cancer. Currently, only sex-specific ADR benchmarks are reported. However, obesity and smoking ≥20 pack-years are strong predictors for colorectal neoplasia, as highlighted by the 2009 American College of Gastroenterology CRC Screening Guidelines. Data comparing ADR in smokers and obese adults to those without these risks are limited.
We calculated ADR, SDR, and 95% confidence intervals for screening colonoscopies in participants ≥50 years. Sex-specific and sex-age-specific rates were compared by smoking exposure (never vs. <20 vs. ≥20 pack-years) and body mass index (<30 vs. ≥30).
A total of 21,539 screening colonoscopies were performed by 77 endoscopists at 20 facilities (April 2009 to September 2013). The difference in ADR between nonsmokers and smokers with ≥20 pack-years was 8.8% (P<0.0001) and between obesity groups 5.0% (P<0.0001). Significant sex-specific and sex-age-specific increases in ADR and SDR were found among smokers and obese participants.
ADR and SDR for smokers and obese adults were significantly higher than their counterparts without those risks. Endoscopists should consider the prevalence of these risks within their screening population when comparing their rates to established benchmarks. Calculating sex-specific or sex-age-specific ADR and SDR based on smoking and obesity may provide optimal protection for populations with a particularly high prevalence of smokers and obese adults.
在新罕布什尔结肠镜检查登记处中，检查吸烟者和肥胖成年人的腺瘤筛查检出率（ADR）和锯齿状病变检出率（SDR）。
ADR作为结肠镜筛查的一项质量指标，与预防间隔期结直肠癌相关。目前，仅报告了按性别划分的ADR基准。然而，正如2009年美国胃肠病学会结直肠癌筛查指南所强调的，肥胖和吸烟≥20包年是结直肠肿瘤的有力预测因素。将吸烟者和肥胖成年人的ADR与无这些风险因素者进行比较的数据有限。
我们计算了年龄≥50岁参与者结肠镜筛查的ADR、SDR及95%置信区间。按吸烟暴露情况（从不吸烟、<20包年、≥20包年）和体重指数（<30、≥30）比较了按性别及按性别和年龄划分的比率。
20家机构的77名内镜医师共进行了21,539例结肠镜筛查（2009年4月至2013年9月）。非吸烟者与吸烟≥20包年者之间的ADR差异为8.8%（P<0.0001），肥胖组之间的差异为5.0%（P<0.0001）。在吸烟者和肥胖参与者中发现了按性别及按性别和年龄划分的ADR和SDR显著增加。
吸烟者和肥胖成年人的ADR和SDR显著高于无这些风险因素的成年人。内镜医师在将自己的比率与既定基准进行比较时，应考虑筛查人群中这些风险因素的流行情况。基于吸烟和肥胖情况计算按性别或按性别和年龄划分的ADR和SDR，可能为吸烟者和肥胖成年人患病率特别高的人群提供最佳保护。
