Dong Zhiyu, Sun Huihui, Li Bo, Zhang Qiongmei, Sun Kejing, Wang Zhenxiang, Qian Xue, Wang Junwen, Zhan Tingting, Jiang Yuanxi, Chen Ying, Xu Shuchang
Department of Gastroenterology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.
J Gastroenterol Hepatol. 2021 Jun;36(6):1649-1655. doi: 10.1111/jgh.15314. Epub 2020 Nov 13.
The number of colonoscopies required to reach satisfactory adenoma detection rate (ADR) is not well established. The aim of this study was to identify the appropriate number of procedures required to attain satisfactory ADR for those well-trained endoscopists who have a cecal intubation rate (CIR) ≥ 90% and start to perform colonoscopy independently.
All endoscopists with compelete independent colonoscopy data during career in our database were enrolled. The number of procedures required to achieve ADR ≥ 20% was identified by cumulative summation (Cusum), learning curve Cusum (LC-Cusum), and moving average method. Mixed effect logistic regression model was developed to determine the relationship between endoscopist as well as patient-related factors and adenoma detection.
A total of 24 943 procedures and 14 endoscopists were enrolled. By Cusum analysis, the interest point was at 207 procedures. By LC-Cusum analysis, 71% (10/14) and 86% (12/14) of endoscopists had attained satisfactory ADR after 200 and 300 procedures, respectively. By moving average method, endoscopists reached a mean ADR of 20% at 216 and 261 procedures over blocks of 50 and 100 procedures, respectively. The total number of procedures, number of daily procedures, patient age and gender, bowel preparation, sedation, and diverticulosis were significantly associated with adenoma detection.
This is the first study to investigate the learning curve of ADR for those well-trained endoscopists who have a CIR ≥ 90% and start to perform colonoscopy independently. Two hundred procedures might be an optimal number required to reach an ADR ≥ 20%.
达到满意的腺瘤检出率（ADR）所需的结肠镜检查次数尚未明确确定。本研究的目的是确定对于那些盲肠插管率（CIR）≥90%且开始独立进行结肠镜检查的训练有素的内镜医师，达到满意ADR所需的适当检查次数。
纳入我们数据库中在职业生涯中有完整独立结肠镜检查数据的所有内镜医师。通过累积求和（Cusum）、学习曲线Cusum（LC-Cusum）和移动平均法确定达到ADR≥20%所需的检查次数。建立混合效应逻辑回归模型以确定内镜医师以及患者相关因素与腺瘤检出之间的关系。
共纳入24943例检查和14名内镜医师。通过Cusum分析，关注点在207例检查时。通过LC-Cusum分析，分别有71%（10/14）和86%（12/14）的内镜医师在200例和300例检查后达到了满意的ADR。通过移动平均法，内镜医师在每50例和100例检查的分组中，分别在216例和261例检查时达到了20%的平均ADR。检查总次数、每日检查次数、患者年龄和性别、肠道准备、镇静和憩室病与腺瘤检出显著相关。
这是第一项针对那些CIR≥90%且开始独立进行结肠镜检查的训练有素的内镜医师研究ADR学习曲线的研究。200例检查可能是达到ADR≥20%所需的最佳次数。
