Jaho File, Kroijer Rasmus, Ploug Magnus
Department of Surgical Gastroenterology, Hospital South West Jutland, Esbjerg, Denmark.
Ann Gastroenterol. 2021 Nov-Dec;34(6):815-819. doi: 10.20524/aog.2021.0668. Epub 2021 Oct 12.
The diagnostic quality of screening colonoscopies has been found to differ between morning and afternoon. Specifically, the adenoma detection rate (ADR) is higher in the morning. Our aim was to assess if time-of-day dependent differences in colonoscopy quality exist in a Danish screening setting. Following national screening guidelines, an individual will be exempt from screening invitations for 8 years if the colonoscopy is without pathology. Therefore, it is of utmost importance to identify factors systematically affecting the detection of lesions.
This was a single-center study of screening colonoscopies performed between 2014 and 2018. Records were retrieved from the Danish Colorectal Cancer Screening Database and coupled with local data. The ADR and the cecal intubation rate were compared between morning (8-12 a.m.) and afternoon (12-4 p.m.) colonoscopies. Multivariate logistic regression analysis was performed.
A total of 3659 screening colonoscopies were included. The ADR was 51% in the morning and 58% in the afternoon. Multivariate analysis found this statistically significant, with the "afternoon vs. morning" odds ratio for adenoma detection being 1.4 (95% confidence interval 1.17-1.68; P<0.001). The cecal intubation rate was 95.6% in the morning and 94.7%, a non-significant difference.
The ADR of screening colonoscopies was higher in the afternoon. Our study highlights the need for local/regional evaluation of factors affecting colonoscopy quality to address such issues. A clean colonoscopy exempts the patient from subsequent screening invitations for 8 years. Therefore, any observed systematic differences in quality must be addressed and eliminated.
已发现筛查性结肠镜检查的诊断质量在上午和下午有所不同。具体而言，腺瘤检出率（ADR）在上午更高。我们的目的是评估在丹麦的筛查环境中是否存在结肠镜检查质量的时间依赖性差异。根据国家筛查指南，如果结肠镜检查未发现病变，个人将在8年内免于筛查邀请。因此，识别系统影响病变检测的因素至关重要。
这是一项对2014年至2018年间进行的筛查性结肠镜检查的单中心研究。记录从丹麦结直肠癌筛查数据库中检索，并与本地数据相结合。比较上午（上午8点至12点）和下午（下午12点至4点）结肠镜检查的ADR和盲肠插管率。进行多变量逻辑回归分析。
共纳入3659例筛查性结肠镜检查。上午的ADR为51%，下午为58%。多变量分析发现这具有统计学意义，腺瘤检测的“下午与上午”优势比为1.4（95%置信区间1.17 - 1.68；P<0.001）。上午的盲肠插管率为95.6%，下午为94.7%，差异无统计学意义。
筛查性结肠镜检查的ADR在下午更高。我们的研究强调需要对影响结肠镜检查质量的因素进行本地/区域评估，以解决此类问题。一次清洁的结肠镜检查可使患者在随后8年内免于筛查邀请。因此，任何观察到的质量系统差异都必须得到解决并消除。
