Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States.
Harvard Medical School, Boston, Massachusetts, United States.
Endoscopy. 2018 Oct;50(10):984-992. doi: 10.1055/a-0597-1740. Epub 2018 Apr 24.
Serrated polyps are important colorectal cancer precursors that are variably detected during colonoscopy. We measured serrated polyp detection rate (SPDR) in a large, multicenter, cross-sectional study of colonoscopy quality to identify drivers of SPDR variation.
Colonoscopy and pathology reports were collected for a 2-year period (10/2013-9/2015) from four sites across the United States. Data from reports, including size, location, and histology of polyps, were abstracted using a validated natural language processing algorithm. SPDR was defined as the proportion of colonoscopies with ≥ 1 serrated polyp (not including hyperplastic polyps). Multivariable logistic regression was performed to determine endoscopist characteristics associated with serrated polyp detection.
A total of 104 618 colonoscopies were performed by 201 endoscopists who varied with respect to specialty (86 % were gastroenterologists), sex (18 % female), years in practice (range 1 - 51), and number of colonoscopies performed during the study period (range 30 - 2654). The overall mean SPDR was 5.1 % (SD 3.8 %, range 0 - 18.8 %). In multivariable analysis, gastroenterology specialty training (odds ratio [OR] 1.89, 95 % confidence interval [CI] 1.33 - 2.70), fewer years in practice (≤ 9 years vs. ≥ 27 years: OR 1.52, 95 %CI 1.14 - 2.04)], and higher procedure volumes (highest vs. lowest quartile: OR 1.77, 95 %CI 1.27 - 2.46)] were independently associated with serrated polyp detection.
Gastroenterology specialization, more recent completion of training, and greater procedure volume are associated with serrated polyp detection. These findings imply that both repetition and training are likely to be important contributors to adequate detection of these important cancer precursors. Additional efforts to improve SPDR are needed.
锯齿状息肉是重要的结直肠癌前体，在结肠镜检查中会有不同程度的发现。我们在一项大型的、多中心的结肠镜质量横断面研究中测量了锯齿状息肉检出率（SPDR），以确定 SPDR 变化的驱动因素。
在 2013 年 10 月至 2015 年 9 月期间，从美国四个地点收集了结肠镜检查和病理报告。使用经过验证的自然语言处理算法从报告中提取息肉的大小、位置和组织学等数据。SPDR 定义为结肠镜检查中检出≥1 个锯齿状息肉（不包括增生性息肉）的比例。采用多变量逻辑回归分析确定与锯齿状息肉检出相关的内镜医生特征。
共进行了 104618 例结肠镜检查，由 201 名内镜医生完成，他们的专业（86%为胃肠病学家）、性别（18%为女性）、从业年限（1-51 年）和研究期间结肠镜检查数量（30-2654 例）存在差异。总体平均 SPDR 为 5.1%（标准差 3.8%，范围 0-18.8%）。多变量分析显示，胃肠病学专业培训（优势比[OR]1.89，95%置信区间[CI]1.33-2.70）、从业年限较短（≤9 年与≥27 年：OR 1.52，95%CI 1.14-2.04）和较高的手术量（最高与最低四分位数：OR 1.77，95%CI 1.27-2.46）与锯齿状息肉检出独立相关。
胃肠病学专业、近期完成培训和更大的手术量与锯齿状息肉的检出相关。这些发现表明，重复和培训都可能是充分发现这些重要癌前体的重要因素。需要进一步努力提高 SPDR。
