临床显著锯齿状息肉检出率及结肠镜检查后的结直肠癌风险：来自新罕布什尔州结肠镜检查登记处的数据。
Clinically significant serrated polyp detection rates and risk for postcolonoscopy colorectal cancer: data from the New Hampshire Colonoscopy Registry.
机构信息
Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA; White River Junction VAMC, White River Junction, Vermont, USA.
Department of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA; New Hampshire Colonoscopy Registry, Lebanon, New Hampshire, USA.
出版信息
Gastrointest Endosc. 2022 Aug;96(2):310-317. doi: 10.1016/j.gie.2022.03.001. Epub 2022 Mar 8.
BACKGROUND AND AIMS
Higher adenoma detection rates reduce the risk of postcolonoscopy colorectal cancer (PCCRC). Clinically significant serrated polyps (CSSPs; defined as any sessile serrated polyp, traditional serrated adenoma, large [≥1 cm] or proximal hyperplastic polyp >5 mm) also lead to PCCRC, but there are no data on associated CSSP detection rates (CSSDRs). We used data from the New Hampshire Colonoscopy Registry (NHCR) to investigate the association between PCCRC risk and endoscopist CSSDR.
METHODS
We included NHCR patients with 1 or more follow-up events: either a colonoscopy or a colorectal cancer (CRC) diagnosis identified through linkage with the New Hampshire State Cancer Registry. We defined our outcome, PCCRC, in 3 time periods: CRC diagnosed 6 to 36 months, 6 to 60 months, or all examinations (6 months or longer) after an index examination. We excluded patients with CRC diagnosed at or within 6 months of the index examination, with incomplete examinations, or with inflammatory bowel disease. The exposure variable was endoscopist CSSDR at the index colonoscopy. Cox regression was used to model the hazard of PCCRC on CSSDR controlling for age, sex, index findings, year of examination, personal history of colorectal neoplasia, and having more than 1 surveillance examination.
RESULTS
One hundred twenty-eight patients with CRC diagnosed at least 6 months after their index examination were included. Our cohort included 142 endoscopists (92 gastroenterologists). We observed that the risk for PCCRC 6 months or longer after the index examination was significantly lower for examinations performed by endoscopists with CSSDRs of 3% to <9% (hazard ratio [HR], .57; 95% confidence interval [CI], .39-.83) or 9% or higher (HR, .39; 95% CI, .20-.78) relative to those with CSSDRs under 3%.
CONCLUSIONS
Our study is the first to demonstrate a lower PCCRC risk after examinations performed by endoscopists with higher CSSDRs. Both CSSDRs of 9% and 3% to <9% had statistically lower risk of PCCRC than CSSDRs of <3%. These data validate CSSDR as a clinically relevant quality measure for endoscopists.
背景与目的
更高的腺瘤检出率可降低结直肠腺瘤内镜切除术后结直肠癌（postcolonoscopy colorectal cancer，PCCRC）的风险。临床上有意义的锯齿状息肉（clinically significant serrated polyps，CSSPs；定义为任何无蒂锯齿状息肉、传统锯齿状腺瘤、大[≥1cm]或近端增生性息肉＞5mm）也可导致 PCCRC，但 CSSP 检出率（CSSDR）的数据尚缺乏。我们使用新罕布什尔州结肠镜检查登记处（New Hampshire Colonoscopy Registry，NHCR）的数据，调查了 PCCRC 风险与内镜医生 CSSDR 之间的关系。
方法
我们纳入了 NHCR 中至少有 1 次随访事件的患者：通过与新罕布什尔州癌症登记处的链接，随访事件为结肠镜检查或结直肠癌（colorectal cancer，CRC）诊断。我们将 PCCRC 定义为 3 个时间段内的 CRC 诊断：6 至 36 个月、6 至 60 个月或指数检查后 6 个月或更长时间。我们排除了在指数检查时或检查后 6 个月内诊断为 CRC、检查不完整或患有炎症性肠病的患者。暴露变量为指数结肠镜检查时内镜医生的 CSSDR。采用 Cox 回归模型控制年龄、性别、指数检查结果、检查年份、结直肠肿瘤个人史和接受超过 1 次监测检查后，分析 PCCRC 与 CSSDR 的风险比（hazard ratio，HR）。
结果
纳入了 128 例至少在指数检查后 6 个月诊断为 CRC 的患者。我们的队列纳入了 142 名内镜医生（92 名胃肠病学家）。我们发现，与 CSSDR＜3%的内镜医生相比，CSSDR 为 3%～＜9%（HR，0.57；95%置信区间，0.39～0.83）或≥9%（HR，0.39；95%置信区间，0.20～0.78）的内镜医生进行的检查后，指数检查后 6 个月或更长时间发生 PCCRC 的风险显著降低。
结论
我们的研究首次证明，CSSDR 较高的内镜医生进行的检查后，PCCRC 的风险较低。CSSDR 为 9%和 3%～＜9%的患者发生 PCCRC 的风险均显著低于 CSSDR＜3%的患者。这些数据验证了 CSSDR 作为内镜医生的一项临床相关质量指标。
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