Anderson Joseph C, Butterly Lynn F, Weiss Julia E, Robinson Christina M
Department of Veterans Affairs Medical Center, White River Junction, Vermont, USA; The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.
The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA; Dartmouth Hitchcock Medical Center, Section of Gastroenterology, Lebanon, New Hampshire, USA.
Gastrointest Endosc. 2017 Jun;85(6):1188-1194. doi: 10.1016/j.gie.2017.01.020. Epub 2017 Jan 31.
Similar to achieving adenoma detection rate (ADR) benchmarks to prevent colorectal cancer (CRC), achieving adequate serrated polyp detection rates (SDRs) may be essential to the prevention of CRC associated with the serrated pathway. Previous studies have been based on data from high-volume endoscopists at single academic centers. Based on a hypothesis that ADR is correlated with SDR, we stratified a large, diverse group of endoscopists (n = 77 practicing at 28 centers) into high performers and low performers, based on ADR, to provide data for corresponding target SDR benchmarks.
By using colonoscopies in adults aged ≥50 years (4/09-12/14), we stratified endoscopists by high and low ADRs (<15%, 15%-<25%, 25%-<35%, ≥35%) to determine corresponding SDRs by using 2 SDR measures, for screening and surveillance colonoscopies separately: (1) Clinically significant SDR (CSSDR), meaning colonoscopies with any sessile serrated adenoma/polyp (SSA/P), traditional serrated adenoma (TSA), or hyperplastic polyp (HP) >1 cm anywhere in the colon or HP >5 mm in the proximal colon only divided by the total number of screening and surveillance colonoscopies, respectively. (2) Proximal SDR (PSDR) meaning colonoscopies with any serrated polyp (SSA/P, HP, TSA) of any size proximal to the sigmoid colon divided by the total number of screening and surveillance colonoscopies, respectively.
A total of 45,996 (29,960 screening) colonoscopies by 77 endoscopists (28 facilities) were included. Moderately strong positive correlation coefficients were observed for screening ADR/CSSDR (P = .69) and ADR/PSDR (P = .79) and a strong positive correlation (P = .82) for CSSDR/PSDR (P < .0001 for all) was observed. For ADR ≥25%, endoscopists' median (interquartile range) screening CSSDR was 6.8% (4.3%-8.6%) and PSDR was 10.8% (8.6%-16.1%).
Derived from ADR, the primary colonoscopy quality indicator, our results suggest potential SDR benchmarks (CSSDR = 7% and PSDR = 11%) that may guide adequate serrated polyp detection. Because CSSDR and PSDR are strongly correlated, endoscopists could use the simpler PSDR calculation to assess quality.
与达到腺瘤检出率（ADR）基准以预防结直肠癌（CRC）类似，实现足够的锯齿状息肉检出率（SDR）对于预防与锯齿状途径相关的CRC可能至关重要。既往研究基于单一学术中心大量内镜医师的数据。基于ADR与SDR相关的假设，我们根据ADR将一大群多样化的内镜医师（n = 77，在28个中心执业）分为高绩效者和低绩效者，以提供相应目标SDR基准的数据。
通过对年龄≥50岁的成年人进行结肠镜检查（2009年4月至2014年12月），我们根据高和低ADR（<15%、15% - <25%、25% - <35%、≥35%）对内镜医师进行分层，分别使用两种SDR测量方法来确定相应的SDR，用于筛查结肠镜检查和监测结肠镜检查：（1）临床显著SDR（CSSDR），指结肠镜检查中在结肠任何部位有任何无蒂锯齿状腺瘤/息肉（SSA/P）、传统锯齿状腺瘤（TSA）或增生性息肉（HP）>1 cm，或仅在近端结肠有HP>5 mm，分别除以筛查和监测结肠镜检查的总数。（2）近端SDR（PSDR），指结肠镜检查中在乙状结肠近端有任何大小的锯齿状息肉（SSA/P、HP、TSA），分别除以筛查和监测结肠镜检查的总数。
纳入了77名内镜医师（28个机构）进行的总共45,996例（29,960例筛查）结肠镜检查。观察到筛查ADR/CSSDR（P = 0.69）和ADR/PSDR（P = 0.79）之间存在中度强正相关系数，并且观察到CSSDR/PSDR之间存在强正相关（P = 0.82）（所有P < 0.0001）。对于ADR≥25%，内镜医师的筛查CSSDR中位数（四分位间距）为6.8%（4.3% - 8.6%），PSDR为10.8%（8.6% - 16.1%）。
从主要的结肠镜检查质量指标ADR得出，我们的结果提示了潜在的SDR基准（CSSDR = 7%和PSDR = 11%），这可能指导足够的锯齿状息肉检测。由于CSSDR和PSDR密切相关，内镜医师可以使用更简单的PSDR计算来评估质量。
