Taveira Filipe, Areia Miguel, Elvas Luís, Alves Susana, Brito Daniel, Saraiva Sandra, Cadime Ana Teresa
Department of Gastroenterology, Portuguese Oncology Institute, Coimbra, Portugal.
CINTESIS - Center for Research in Health Technologies and Information Systems, Faculty of Medicine, University of Porto, Porto, Portugal.
GE Port J Gastroenterol. 2017 Sep;24(5):211-218. doi: 10.1159/000478940. Epub 2017 Jul 21.
Colonoscopy quality is a hot topic in gastroenterological communities, with several actual guidelines focusing on this aspect. Although the adenoma detection rate (ADR) is the single most important indicator, several other metrics are described and need reporting. Electronic medical reports are essential for the audit of quality indicators; nevertheless, they have proved not to be faultless.
The aim of this study was to analyse and audit quality indicators (apart from ADR) using only our internal electronic endoscopy records as a starting point for improvement.
An analysis of electronically recorded information of 8,851 total colonoscopies from a single tertiary centre from 2010 to 2015 was performed.
The mean patient age was 63.4 ± 8.5 years; 45.5% of them were female, and in 14.6% sedation was used. Photographic documentation was done in 98.4% with 10.7 photographs on average, and 37.4% reports had <8 pictures per exam. Bowel preparation was rated as adequate in 67%, fair in 27% and inadequate in 4.9% of cases. The adjusted caecal intubation rate (CIR) was 92%, while negative predictors were inadequate preparation (OR 119, 95% CI 84-170), no sedation (OR 2.39, 95% CI 1.81-3.15), female gender (OR 1.61, 95% CI 1.38-1.88) and age ≥65 years (OR 1.56, 95% CI 1.34-1.82). In 28% of patients, a snare polypectomy was performed, correlating with adequate preparation (OR 5.75, 95% CI 3.90-8.48), male gender (OR 1.82, 95% CI 1.64-2.01) and age ≥65 years (OR 1.25, 95% CI 1.13-1.37; < 0.01) as positive predictors. An annual evolution was observed with improvements in photographic documentation (10.7 vs. 12.9; < 0.001), CIR (91 vs. 94%; = 0.002) and "adequate" bowel preparation ( = 0.004). There is much more to report than the ADR to ensure quality in colonoscopy practice. Better registry systematization and integrated software should be goals to achieve in the short term.
结肠镜检查质量是胃肠病学界的一个热门话题，有多项现行指南关注这一方面。虽然腺瘤检出率（ADR）是最重要的单一指标，但还描述了其他一些指标且需要报告。电子病历对于质量指标的审核至关重要；然而，事实证明它们并非完美无缺。
本研究的目的是仅以我们内部的电子内镜记录为起点进行分析和审核质量指标（ADR除外），以实现改进。
对2010年至2015年来自单个三级中心的8851例全结肠镜检查的电子记录信息进行分析。
患者平均年龄为63.4±8.5岁；其中45.5%为女性，14.6%使用了镇静剂。98.4%的检查有摄影记录，平均有10.7张照片，37.4%的报告每次检查的照片<8张。67%的病例肠道准备被评为充分，27%为中等，4.9%为不充分。调整后的盲肠插管率（CIR）为92%，而阴性预测因素为准备不充分（比值比119，95%置信区间84 - 170）、未使用镇静剂（比值比2.39，95%置信区间1.81 - 3.15）、女性（比值比1.61，95%置信区间1.38 - 1.88）和年龄≥65岁（比值比1.56，95%置信区间1.34 - 1.82）。28%的患者进行了圈套息肉切除术，与准备充分（比值比5.75，95%置信区间3.90 - 8.48）、男性（比值比1.82，95%置信区间1.64 - 2.01）和年龄≥65岁（比值比1.25，95%置信区间1.13 - 1.37；P<0.01）呈正相关，为阳性预测因素。观察到年度进展，摄影记录（10.7对12.9；P<0.001）、CIR（91%对94%；P = 0.002）和“充分”的肠道准备（P = 0.004）均有所改善。为确保结肠镜检查实践的质量，需要报告的内容远不止ADR。更好的登记系统化和集成软件应是短期内要实现的目标。
