Matyja Maciej, Pasternak Artur, Szura Mirosław, Wysocki Michał, Pędziwiatr Michał, Rembiasz Kazimierz
2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.
Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland.
Arch Med Sci. 2019 Mar;15(2):424-433. doi: 10.5114/aoms.2018.74863. Epub 2018 Apr 6.
Colonoscopy has been widely regarded as the gold standard in colorectal cancer (CRC) screening. Within recent years different endoscopic imaging techniques have been introduced to improve the quality of colonoscopy. The adenoma detection rate (ADR) is the single most important quality indicator for colonoscopy. The aim of this study was to evaluate the quality of CRC screening expressed by ADR in two different eras of endoscopic technology advancement.
We conducted a dual-center study that enrolled 24 055 patients, who underwent colonoscopy as part of a national screening program. Patients were sorted into two groups according to the advancement of endoscopic equipment used for colonoscopic examination: group I - 10 405 patients examined between 2004 and 2008 (standard electronic endoscopes); group II - 13 650 patients examined between 2009 and 2014 (modern endoscopes). The ADR in two different eras and the impact of endoscopic novelties were determined.
The ADR in group I was 29.14%, in group II 31.73% ( < 0.001). The overall ADR was 30.88% - 38.80% and 25.95% ( < 0.001) for the male and female patients, respectively. The mean adenoma number per colonoscopy was 0.366 (95% CI: 0.357-0.375; < 0.001), 0.337 (0.321-0.352) and 0.380 (0.369-0.392) for patients in group I and group II, respectively.
Our study shows that technological innovation, novel endoscopy devices and diagnostic techniques improve the quality in CRC screening by increasing the ADR. However, we need to determine which of the technologies are supreme to achieve excellence in colorectal cancer screening.
结肠镜检查一直被广泛视为结直肠癌（CRC）筛查的金标准。近年来，为提高结肠镜检查质量，引入了不同的内镜成像技术。腺瘤检出率（ADR）是结肠镜检查最重要的单一质量指标。本研究的目的是评估在内镜技术发展的两个不同时期，以ADR表示的CRC筛查质量。
我们进行了一项双中心研究，纳入了24055例作为国家筛查项目一部分接受结肠镜检查的患者。根据用于结肠镜检查的内镜设备的先进性，将患者分为两组：第一组 - 2004年至2008年期间检查的10405例患者（标准电子内镜）；第二组 - 2009年至2014年期间检查的13650例患者（现代内镜）。确定了两个不同时期的ADR以及内镜新技术的影响。
第一组的ADR为29.14%，第二组为31.7%（<0.001）。男性和女性患者的总体ADR分别为30.88% - 38.80%和25.95%（<0.001）。第一组和第二组患者每次结肠镜检查的平均腺瘤数分别为0.366（95%CI：0.357 - 0.375；<0.001）、0.337（0.321 - 0.352）和0.380（0.369 - 0.392）。
我们的研究表明，技术创新、新型内镜设备和诊断技术通过提高ADR改善了CRC筛查的质量。然而，我们需要确定哪些技术是实现卓越结直肠癌筛查的最佳技术。
