Yang Sun Young, Quan Susan Y, Friedland Shai, Pan Jennifer Y
Division of Gastroenterology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea.
Veterans Affairs Palo Alto Health Care System, Palo Alto, California, United States.
Endosc Int Open. 2021 Feb;9(2):E216-E223. doi: 10.1055/a-1321-0990. Epub 2021 Feb 3.
In 2015, the American Society for Gastrointestinal Endoscopy (ASGE) and American College of Gastroenterology (ACG) Task Force on Quality in Endoscopy deemed adenoma detection rate (ADR) the most important quality measure for colonoscopy. There has been much interest in factors that can increase ADR. To date, however, few studies have looked at what intra-procedural endoscopist practices are associated with improving ADR. We conducted a retrospective review of colonoscopy videos to evaluate intra-procedural practices that could be associated with ADR. Videos were recorded of colonoscopies performed between September and December 2017 at the Palo Alto Veterans Affairs Health Care System. Colonoscopies for screening and surveillance were included for video review. Factors assessed included withdrawal time, intra-procedural cleaning, inspection technique, and other variables (colon distention, removal of equivocal/hyperplastic polyps). A series of multiple regression analyses was conducted on variables of interest before running a final model of significant predictors. A total of 130 videos were reviewed from nine endoscopists whose ADRs ranged between 37.5 % and 73.7 %. The final regression model was significant (F = 15.35, df = 2, = 0.0044), R = 0.8365) with close inspection of behind folds and quality of cecal inspection being the factors highly correlated with predicting ADR. Withdrawal and inspection times, colonic wall distention, removal of equivocal/hyperplastic polyps, quality of rectal inspection, suctioning, and washing were factors moderately correlated with predicting ADR. We found that behind-fold inspection and a meticulous cecal inspection technique were predictive of a high ADR.
2015年，美国胃肠内镜学会（ASGE）和美国胃肠病学会（ACG）内镜质量特别工作组将腺瘤检出率（ADR）视为结肠镜检查最重要的质量指标。人们对可提高ADR的因素颇感兴趣。然而，迄今为止，很少有研究探讨术中内镜医师的哪些操作与ADR的改善相关。我们对结肠镜检查视频进行了回顾性分析，以评估可能与ADR相关的术中操作。 视频记录了2017年9月至12月在帕洛阿尔托退伍军人事务医疗保健系统进行的结肠镜检查。纳入用于视频回顾的筛查和监测结肠镜检查。评估的因素包括退镜时间、术中清洁、检查技术以及其他变量（结肠扩张、切除可疑/增生性息肉）。在运行最终的显著预测因子模型之前，对感兴趣的变量进行了一系列多元回归分析。 共回顾了来自9位内镜医师的130个视频，他们的ADR在37.5%至73.7%之间。最终回归模型具有显著性（F = 15.35，df = 2， = 0.0044），R = 0.8365），对皱襞后方的仔细检查和盲肠检查质量是与预测ADR高度相关的因素。退镜和检查时间、结肠壁扩张、切除可疑/增生性息肉、直肠检查质量、吸引和冲洗是与预测ADR中度相关的因素。 我们发现，对皱襞后方的检查和细致的盲肠检查技术可预测高ADR。
