Amano Takahiro, Nishida Tsutomu, Shimakoshi Hiromi, Shimoda Akiyoshi, Osugi Naoto, Sugimoto Aya, Takahashi Kei, Mukai Kaori, Nakamatsu Dai, Matsubara Tokuhiro, Yamamoto Masashi, Hayashi Shiro, Nakajima Sachiko, Fukui Koji, Inada Masami
Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan.
Endosc Int Open. 2018 Jul;6(7):E878-E884. doi: 10.1055/a-0605-3264. Epub 2018 Jul 4.
Adenoma detection rate (ADR) is a well-known quality indicator (QI) for colonoscopy. It is, however, difficult to evaluate ADR during practice. The aim of this study was to investigate the number of endoscopically detected polyps as a QI for colonoscopy.
This was a retrospective single-center cohort study of 5,190 consecutive patients who underwent colonoscopy from January 2015 to May 2016. Among these patients, we ultimately enrolled 1,937 patients for initial colonoscopy. We evaluated QIs including bowel preparation, cecum intubation time, withdrawal time, number of endoscopically detected polyps, ADR and advanced neoplasia detection rate (ANDR).
The mean number of endoscopically detected polyps, ADR and ANDR were 1.5 ± 2.3 (95 % confidence interval (CI)1.4 - 1.6), 38.6 % (95 % CI 36.5-40.8), and 18.3 % (95 % CI 16.6 - 20.1), respectively. ADR and ANDR increased with the number of endoscopically detected polyps, but the correlation reached a plateau at five or more polyps. We divided the patients into three groups based on the number of polyps (1 to 2, 3 to 4, and 5 or more). Logistic regression analysis adjusted by age and sex revealed that presence of a large number of polyps was a strong predictor of advanced neoplasia (odds ratio: 3.1 [95 % CI 2.2 - 4.3] for 3 to 4 polyps and 7.9 [95 % CI 5.4 - 11.8] for 5 or more polyps when using the presence of 1 or 2 polyps as a reference).
The number of endoscopically detected polyps can predict risk of advanced neoplasia and may thus be a new QI for colonoscopy.
腺瘤检出率（ADR）是结肠镜检查中一项广为人知的质量指标（QI）。然而，在实际操作过程中评估ADR存在困难。本研究旨在调查内镜下检出息肉的数量作为结肠镜检查的一项质量指标。
这是一项回顾性单中心队列研究，研究对象为2015年1月至2016年5月期间连续接受结肠镜检查的5190例患者。在这些患者中，我们最终纳入1937例接受初次结肠镜检查的患者。我们评估了包括肠道准备、盲肠插管时间、退镜时间、内镜下检出息肉数量、ADR以及高级别瘤变检出率（ANDR）在内的质量指标。
内镜下检出息肉的平均数量、ADR和ANDR分别为1.5±2.3（95%置信区间[CI]1.4 - 1.6）、38.6%（95%CI 36.5 - 40.8）和18.3%（95%CI 16.6 - 20.1）。ADR和ANDR随着内镜下检出息肉数量的增加而升高，但在息肉数量达到5个或更多时，这种相关性趋于平稳。我们根据息肉数量将患者分为三组（1至2个、3至4个以及5个或更多）。经年龄和性别校正的逻辑回归分析显示，大量息肉的存在是高级别瘤变的有力预测因素（以1或2个息肉的存在作为参照时，3至4个息肉的优势比为3.1[95%CI 2.2 - 4.3]，5个或更多息肉的优势比为7.9[95%CI 5.4 - 11.8]）。
内镜下检出息肉的数量能够预测高级别瘤变风险，因此可能成为结肠镜检查的一项新的质量指标。
