Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea.
Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Korean J Intern Med. 2021 Mar;36(Suppl 1):S35-S43. doi: 10.3904/kjim.2019.117. Epub 2020 May 12.
BACKGROUND/AIMS: High-quality colonoscopy is essential to reduce colorectal cancer-related deaths. Little is known about colonoscopy quality in non-academic practice settings. We aimed to evaluate the quality of colonoscopies performed in community hospitals and nonhospital facilities.
Colonoscopy data were collected from patients referred to six tertiary care centers after receiving colonoscopies at community hospitals and nonhospital facilities. Based on their photographs, we measured quality indicators including cecal intubation rate, withdrawal time, adequacy of bowel preparation, and number of polyps.
Data from a total of 1,064 colonoscopies were analyzed. The overall cecal intubation rate was 93.1%. The median withdrawal time was 8.3 minutes, but 31.3% of colonoscopies were withdrawn within 6 minutes. Community hospitals had longer withdrawal time and more polyps than nonhospital facilities (median withdrawal time: 9.9 minutes vs. 7.5 minutes, p < 0.001; mean number of polyps: 3.1 vs. 2.3, p = 0.001). Board-certified endoscopists had a higher rate of cecal intubation than non-board-certified endoscopists (93.2% vs. 85.2%, p = 0.006). A total of 819 follow-up colonoscopies were performed at referral centers with a median interval of 28 days. In total, 2,546 polyps were detected at baseline, and 1,088 were newly identified (polyp miss rate, 29.9%). Multivariable analysis revealed that older age (odds ratio [OR], 1.032; 95% confidence interval [CI], 1.020 to 1.044) and male sex (OR, 1.719; 95% CI, 1.281 to 2.308) were associated with increased risk of missed polyps.
The quality of colonoscopies performed in community hospitals and nonhospital facilities was suboptimal. Systematic reporting, auditing, and feedback are needed for quality improvement.
背景/目的：高质量的结肠镜检查对于降低结直肠癌相关死亡率至关重要。然而，在非学术实践环境中，关于结肠镜检查质量的了解甚少。本研究旨在评估社区医院和非医院设施中进行的结肠镜检查质量。
从转诊至六家三级护理中心的患者中收集了在社区医院和非医院设施接受结肠镜检查的数据。根据照片，我们测量了质量指标，包括盲肠插管率、退出时间、肠道准备充分性和息肉数量。
共分析了 1064 例结肠镜检查的数据。总体盲肠插管率为 93.1%。中位退出时间为 8.3 分钟，但 31.3%的结肠镜检查在 6 分钟内完成。社区医院的退出时间和息肉数量均长于非医院设施（中位退出时间：9.9 分钟比 7.5 分钟，p < 0.001；平均息肉数量：3.1 比 2.3，p = 0.001）。有执照的内镜医生的盲肠插管率高于无执照的内镜医生（93.2%比 85.2%，p = 0.006）。在转诊中心共进行了 819 例后续结肠镜检查，中位间隔为 28 天。基线时共检出 2546 个息肉，其中 1088 个为新发现（息肉遗漏率 29.9%）。多变量分析显示，年龄较大（比值比 [OR]，1.032；95%置信区间 [CI]，1.020 至 1.044）和男性（OR，1.719；95%CI，1.281 至 2.308）与息肉遗漏风险增加相关。
社区医院和非医院设施中进行的结肠镜检查质量不理想。需要进行系统的报告、审核和反馈，以提高质量。
