美国固有锯齿状病变检出率随时间的变化及相关因素：利用 GIQuIC 登记处进行全国抽样的结果。
Variation Over Time and Factors Associated With Detection Rates of Sessile Serrated Lesion Across the United States: Results Form a National Sample Using the GIQuIC Registry.
机构信息
Division of Gastroenterology, Minneapolis VA and University of Minnesota, Minneapolis, Minnesota, USA.
GI Quality Improvement Consortium, Bethesda, Maryland, USA.
出版信息
Am J Gastroenterol. 2021 Jan 1;116(1):95-99. doi: 10.14309/ajg.0000000000000824.
INTRODUCTION
Sessile serrated lesions (SSLs) are important precursor lesions for the CpG island-methylated pathway to colorectal cancer. The reported detection rates of SSL are highly variable, and national or population-based estimates are not available. Patient-, provider-, and procedure-level factors associated with the detection rates of SSL have not been well described. The aim of our study was to study the detection rates of SSL, variability of rates over time, and factors associated with detection rates of SSL in a national sample of patients undergoing colonoscopy using the GIQuIC registry.
METHODS
We used colonoscopies submitted to the GIQuIC registry from 2014 to 2017 on adults, aged 18-89 years. Only the first colonoscopy record per patient was included. Indications for colonoscopy were categorized as screening, diagnostic, and surveillance. We used the hierarchical logistic models to study the factors associated with the detection rates of SSL. The Cochrane-Armitage test was used to study the significance of trend over time.
RESULTS
There were a total of 5,173,211 colonoscopies performed by 3,934 endoscopists during the study period. Among the 2,101,082 screening colonoscopies over the study period in adults older than or equal to 50 years that were complete to the cecum, the average detection rate per endoscopist for SSL was 6.43% (SD 5.18) and 6.25% standardized for the 2010 US population. There was a significant increase in the detection rates of SSLs from screening colonoscopies over the study period from 4.99% in 2014 to 7.09% in 2017 (P trend <0.001). Clinically significant factors associated with higher detection rates of SSL were longer withdrawal times (>11 minutes vs ≤6 minutes) (odds ratio [OR] 9.61; 9.03-10.24), adequate preparation (OR 1.25; 1.22-1.28), female sex (OR 1.17; 1.16-1.18), and use of a specialized gastrointestinal pathology group (OR 1.12; 95% confidence interval 1.04, 1.19).
DISCUSSION
Population-based estimates of the detection rates of SSL are 6% and have increased over time.
简介
无蒂锯齿状病变（SSLs）是结直肠癌 CpG 岛甲基化途径的重要前体病变。SSL 的报道检出率差异很大，目前尚无国家或人群估计值。与 SSL 检出率相关的患者、提供者和程序水平因素尚未得到很好的描述。本研究的目的是使用 GIQuIC 登记处的成年人结肠镜检查数据，研究 SSL 的检出率、随时间变化的检出率变化以及与 SSL 检出率相关的因素。
方法
我们使用了 2014 年至 2017 年 GIQuIC 登记处提交的结肠镜检查，纳入年龄在 18-89 岁的成年人。每个患者仅纳入第一次结肠镜检查记录。结肠镜检查的适应证分为筛查、诊断和监测。我们使用分层逻辑模型研究 SSL 检出率相关的因素。使用 Cochran-Armitage 检验研究随时间变化的趋势的显著性。
结果
研究期间共进行了 5173211 例结肠镜检查，由 3934 名内镜医生完成。在研究期间≥50 岁成人的完整至盲肠的筛查结肠镜检查中，2101082 例中 SSL 的平均检出率为 6.43%（标准差 5.18%），2010 年美国人口标准化检出率为 6.25%。从 2014 年的 4.99%到 2017 年的 7.09%，研究期间 SSL 的检出率呈显著上升趋势（趋势 P<0.001）。与 SSL 较高检出率相关的临床显著因素包括更长的退镜时间（>11 分钟比≤6 分钟）（优势比[OR]9.61；9.03-10.24）、充分的准备（OR 1.25；1.22-1.28）、女性（OR 1.17；1.16-1.18）和使用专门的胃肠病理组（OR 1.12；95%置信区间 1.04，1.19）。
讨论
SSL 的检出率为 6%，基于人群的估计值，并随时间推移而增加。
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