Division of Gastroenterology and Hepatology, Medstar Georgetown University Hospital, Washington, DC, USA.
Department of Medicine, Medstar Georgetown University Hospital, Washington, DC, USA.
Dig Dis Sci. 2019 Sep;64(9):2614-2621. doi: 10.1007/s10620-019-05664-w. Epub 2019 May 31.
Recent studies have demonstrated that the protective effect of colonoscopy against colorectal cancer is lower in the proximal colon. Proximal serrated polyps, including sessile serrated adenomas and proximal hyperplastic polyps, can be frequently missed and pose a risk of interval cancers.
To investigate the overall adenoma detection rate (ADR) and the proximal serrated polyp detection rate (PSPDR) among academic gastroenterologists, community gastroenterologists, and colorectal surgeons from a single institution, all of whom have received formal training in colonoscopy during their fellowship.
All complete screening colonoscopies for patients aged 50 or older with a good to excellent bowel preparation performed by different endoscopists at Medstar Washington Hospital Center (Washington, DC) from July 2015 to December 2017 were reviewed. Pathology reports of the resected polyps were manually reviewed.
A total of 2850 screening colonoscopies meeting the inclusion criteria were performed by 18 endoscopists (6 academic, 7 community, and 5 colorectal surgeons). There was no significant difference in the mean ADR among the three groups of endoscopists: academic gastroenterologists, community gastroenterologists, and colorectal surgeons (40.3% vs 36.0% vs 39.6%, respectively). However, academic gastroenterologists had a significantly higher PSPDR compared to community gastroenterologists or colorectal surgeons (12.3% vs 5.4% vs 4.5%, respectively, ANOVA p = 0.006).
Our novel data show that academic gastroenterologists had a significantly higher PSPDR compared to community gastroenterologists or colorectal surgeons despite a comparable overall ADR among the three groups. PSPDR may be considered as an important quality indicator for colonoscopy, apart from ADR.
最近的研究表明，结肠镜检查对结直肠癌的保护作用在近端结肠较低。近端锯齿状息肉，包括无蒂锯齿状腺瘤和近端增生性息肉，可能经常被遗漏，并存在间隔期癌症的风险。
调查来自同一机构的学术胃肠病学家、社区胃肠病学家和结直肠外科医生的总体腺瘤检出率（ADR）和近端锯齿状息肉检出率（PSPDR），他们在住院医师培训期间都接受过结肠镜检查的正规培训。
回顾 2015 年 7 月至 2017 年 12 月期间，在华盛顿特区 Medstar Washington 医院中心，不同内镜医生对年龄在 50 岁及以上、肠道准备良好的患者进行的所有全结肠镜筛查。手动审查切除息肉的病理报告。
共有 18 名内镜医生进行了 2850 例符合纳入标准的筛查性结肠镜检查（6 名学术、7 名社区和 5 名结直肠外科医生）。三组内镜医生的平均 ADR 无显著差异：学术胃肠病学家、社区胃肠病学家和结直肠外科医生分别为 40.3%、36.0%和 39.6%。然而，与社区胃肠病学家或结直肠外科医生相比，学术胃肠病学家的 PSPDR 显著更高（分别为 12.3%、5.4%和 4.5%，ANOVA p=0.006）。
我们的新数据表明，尽管三组之间的总体 ADR 相似，但与社区胃肠病学家或结直肠外科医生相比，学术胃肠病学家的 PSPDR 显著更高。PSPDR 可被视为除 ADR 外，结肠镜检查的一个重要质量指标。
