Causada-Calo Natalia S, Gonzalez-Moreno Emmanuel I, Bishay Kirles, Shorr Risa, Dube Catherine, Heitman Steven J, Hilsden Robert J, Rostom Alaa, Walsh Catharine, Anderson John T, Keswani Rajesh N, Scaffidi Michael A, Grover Samir C, Forbes Nauzer
Division of Gastroenterology, St. Michael's Hospital, Toronto, Canada.
Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Canada.
Endosc Int Open. 2020 Oct;8(10):E1321-E1331. doi: 10.1055/a-1221-4922. Epub 2020 Sep 22.
The quality of screening-related colonoscopy depends on several physician- and patient-related factors. Adenoma detection rate (ADR) varies considerably between endoscopists. Educational interventions aim to improve endoscopists' ADRs, but their overall impact is uncertain. We aimed to assess whether there is an association between educational interventions and colonoscopy quality indicators. A comprehensive search was performed through August 2019 for studies reporting any associations between educational interventions and any colonoscopy quality indicators. Our primary outcome of interest was ADR. Two authors assessed eligibility criteria and extracted data independently. Risk of bias was also assessed for included studies. Pooled rate ratios (RR) with 95 % confidence intervals (CI) were reported using DerSimonian and Laird random effects models. From 2,253 initial studies, eight were included in the meta-analysis for ADR, representing 86,008 colonoscopies. Educational interventions were associated with improvements in overall ADR (RR 1.29, 95 % CI 1.25 to 1.42, 95 % prediction interval 1.09 to 1.53) and proximal ADR (RR 1.39, 95 % CI 1.29 to 1.48), with borderline increases in withdrawal time, ([WT], mean difference 0.29 minutes, 95 % CI - 0.12 to 0.70 minutes). Educational interventions did not affect cecal intubation rate ([CIR], RR 1.01, 95 % CI 1.00 to 1.01). Heterogeneity was considerable across many of the analyses. Educational interventions are associated with significant improvements in ADR, in particular, proximal ADR, and are not associated with improvements in WT or CIR. Educational interventions should be considered an important option in quality improvement programs aiming to optimize the performance of screening-related colonoscopy.
与筛查相关的结肠镜检查质量取决于多个与医生和患者相关的因素。内镜医师之间的腺瘤检出率（ADR）差异很大。教育干预旨在提高内镜医师的ADR，但它们的总体影响尚不确定。我们旨在评估教育干预与结肠镜检查质量指标之间是否存在关联。通过检索截至2019年8月的研究，以查找报告教育干预与任何结肠镜检查质量指标之间关联的研究。我们感兴趣的主要结局是ADR。两位作者独立评估纳入标准并提取数据。还对纳入研究的偏倚风险进行了评估。使用DerSimonian和Laird随机效应模型报告合并率比（RR）及95%置信区间（CI）。在2253项初始研究中，有8项纳入了ADR的荟萃分析，代表86008例结肠镜检查。教育干预与总体ADR的改善相关（RR 1.29，95%CI 1.25至1.42，95%预测区间1.09至1.53）以及近端ADR的改善相关（RR 1.39，95%CI 1.29至1.48），退镜时间有临界增加（[WT]，平均差0.29分钟，95%CI -0.12至0.70分钟）。教育干预未影响盲肠插管率（[CIR]，RR 1.01，95%CI 1.00至1.01）。许多分析中的异质性都相当大。教育干预与ADR的显著改善相关，特别是近端ADR，并且与WT或CIR的改善无关。在旨在优化与筛查相关的结肠镜检查性能的质量改进计划中，应将教育干预视为重要选择。
