Academic Department of Surgery, University Hospital Galway, Galway, Ireland.
, Limerick, Ireland.
Ir J Med Sci. 2021 Nov;190(4):1397-1402. doi: 10.1007/s11845-020-02469-z. Epub 2021 Jan 20.
The European and American colonoscopy guidelines recommend mandatory photodocumentation of caecal intubation to allow retrospective analysis and improve outcomes. We aim to demonstrate whether photodocumentation of caecal intubation improves colonoscopy outcomes.
We extracted images and procedural data from 317 consecutive colonoscopies. Images were anonymised and reviewed by four expert reviewers who scored their certainty that caecal intubation was achieved. Statistical analysis correlated adequately and inadequately photodocumented cases with polyp detection rate (PDR) and adenoma detection rate (ADR).
The patients' mean age was 59.4 years and 52% were male. Eighty-one percent were performed by consultant endoscopists and 19% by specialist registrar. Sixty-five percent of these procedures were performed by gastroenterologists and 35% by surgical endoscopists. Fifty-three percent were deemed to have adequately demonstrated photographic evidence of caecal intubation. Statistical analysis comparing adequately and inadequately photodocumented cases: the PDR of procedures with confirmed caecal intubation was greater than procedures without photographic evidence (40% vs 34%). Similarly, the ADR of photographically confirmed cases was greater than that of inadequately photodocumented cases (25% vs 18%). The number of images taken per procedure positively correlated with photographic documentation of caecal intubation.
While failing to reach statistical significance, there was a nominal difference in ADR and PDR demonstrated between the two groups, and with predominantly positive confidence intervals, this might suggest that a larger sample size could result in significance in favour of photodocumentation of caecal intubation. Future studies would be warranted. However, endoscopists that take more images were more likely to have proven caecal intubation.
欧美结肠镜检查指南建议强制性对盲肠插管进行摄影记录，以允许回顾性分析并改善结果。我们旨在证明盲肠插管的摄影记录是否能改善结肠镜检查的结果。
我们从 317 例连续结肠镜检查中提取了图像和程序数据。图像被匿名化，并由四位专家审查员进行了审查，他们对盲肠插管是否成功的确定性进行了评分。统计学分析将适当和不适当记录的病例与息肉检出率（PDR）和腺瘤检出率（ADR）相关联。
患者的平均年龄为 59.4 岁，52%为男性。81%由顾问内镜医生进行，19%由专科住院医生进行。这些手术中有 65%由胃肠病学家进行，35%由外科内镜医生进行。53%的病例被认为有足够的盲肠插管摄影证据。对适当和不适当记录的病例进行统计学分析：有明确盲肠插管摄影证据的手术的 PDR 大于没有摄影证据的手术（40%比 34%）。同样，摄影证实病例的 ADR 大于不适当记录的病例（25%比 18%）。每个手术拍摄的图像数量与盲肠插管的摄影记录呈正相关。
虽然没有达到统计学意义，但两组之间的 ADR 和 PDR 存在微小差异，并且主要是阳性置信区间，这可能表明更大的样本量可能导致对盲肠插管摄影记录的支持。未来的研究将是必要的。然而，拍摄更多图像的内镜医生更有可能证实盲肠插管。
