Nishida Tsutomu, Nikura Ryota, Nagata Naoyoshi, Honda Tetsuro, Sunagozaka Hajime, Shiratori Yasutoshi, Tsuji Shigetsugu, Sumiyoshi Tetsuya, Fujita Tomoki, Kiyotoki Shu, Yada Tomoyuki, Yamamoto Katsumi, Shinozaki Tomohiro, Nakamatsu Dai, Yamada Atsuo, Fujishiro Mitsuhiro
Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka-shi, Osaka, Japan.
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Endosc Int Open. 2021 Jun;9(6):E943-E954. doi: 10.1055/a-1464-0809. Epub 2021 May 27.
It remains unclear whether the experience of endoscopists affects clinical outcomes for acute lower gastrointestinal bleeding (ALGIB). We aimed to determine the feasibility and safety of colonoscopies performed by nonexperts using secondary data from a randomized controlled trial for ALGIB. We analyzed clinical outcomes in 159 patients with ALGIB who underwent colonoscopies performed by two groups of endoscopists: experts and nonexperts. We compared endoscopy outcomes, including identification of stigmata of recent hemorrhage (SRH), successful endoscopic treatment, adverse events (AEs), and clinical outcomes between the two groups, including 30-day rebleeding, transfusion, length of stay, thrombotic events, and 30-day mortality. Expert endoscopists alone performed colonoscopies in 96 patients, and nonexperts performed colonoscopies in 63 patients. The use of antiplatelets and warfarin was significantly higher in the expert group. The SRH identification rate (24.0 and 17.5 %), successful endoscopic treatment rate (95.0 and 100 %), rate of AEs during colonoscopy (0 and 0 %), transfusion rate (6.3 and 4.8 %), length of stay (8.0 and 6.4 days), rate of thrombotic events (0 and 1.8 %), and mortality (0 and 0 %) were not different between the expert and nonexpert groups. Rebleeding within 30 days occurred more often in the expert group than in the nonexpert group (14.3 vs. 5.4 % = 0.0914). The performance of colonoscopies for ALGIB by nonexperts did not result in worse clinical outcomes, suggesting that its use could be feasible for nonexperts for diagnosis and treatment of ALGIB.
内镜医师的经验是否会影响急性下消化道出血（ALGIB）的临床结局仍不清楚。我们旨在利用一项针对ALGIB的随机对照试验的二级数据，确定非专家进行结肠镜检查的可行性和安全性。我们分析了159例接受两组内镜医师（专家和非专家）进行结肠镜检查的ALGIB患者的临床结局。我们比较了两组之间的内镜检查结果，包括近期出血征象（SRH）的识别、内镜治疗的成功率、不良事件（AE）以及临床结局，包括30天再出血、输血、住院时间、血栓形成事件和30天死亡率。仅专家内镜医师为96例患者进行了结肠镜检查，非专家为63例患者进行了结肠镜检查。专家组使用抗血小板药物和华法林的比例显著更高。专家组和非专家组的SRH识别率（分别为24.0%和17.5%）、内镜治疗成功率（分别为95.0%和100%）、结肠镜检查期间的AE发生率（均为0）、输血率（分别为6.3%和4.8%）、住院时间（分别为8.0天和6.4天）、血栓形成事件发生率（分别为0和1.8%）以及死亡率（均为0）并无差异。专家组30天内再出血的发生率高于非专家组（14.3%对5.4%，P = 0.0914）。非专家进行ALGIB结肠镜检查并未导致更差的临床结局，这表明非专家使用结肠镜检查诊断和治疗ALGIB可能是可行的。
