Sekiguchi Masau, Westerberg Marcus, Ekbom Anders, Hultcrantz Rolf, Forsberg Anna
Cancer Screening Center/Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
Division of Screening Technology, National Cancer Center, Institute for Cancer Control, Tokyo, Japan.
J Gastroenterol Hepatol. 2022 Nov;37(11):2120-2130. doi: 10.1111/jgh.15990. Epub 2022 Sep 9.
Colonoscopy quality, including lesion detectability, is variable, and factors influencing lesion detection are not fully understood. This study investigated lesion detection rates during colonoscopies and the associated factors in the SCREEning of Swedish COlons (SCREESCO) study.
In this cross-sectional analysis of data from SCREESCO, a large-scale randomized controlled trial of colorectal cancer screening in the Swedish population aged 60 years, we assessed data of first-time colonoscopies performed in both colonoscopy and fecal immunochemical test (FIT) arms.
This study included 16 552 individuals. The adenoma detection rate was 23.9% and 37.8% in colonoscopy and FIT arms, respectively. Regarding colonoscopy procedures, a withdrawal time ≥ 6 min was associated with higher detection rates of advanced adenomas (adjusted odds ratio [AOR] 2.474, 95% confidence interval [CI] 1.295-4.723), adenomas (2.181, 1.515-3.140), and proximal serrated lesions (pSLs) (1.713, 1.007-2.915). Antispasmodic use was associated with higher detection rates of these lesions and sessile serrated lesions (SSLs) (AOR, 95% CI: 1.523, 1.295-1.791; 1.361, 1.217-1.522; 1.450, 1.247-1.687; and 1.810, 1.512-2.167, respectively). Insertion time > 20 min was related to lower detection rates of adenomas, pSLs, and SSLs (AOR, 95% CI: 0.753, 0.639-0.887; 0.640, 0.495-0.828; and 0.704, 0.518-0.955, respectively). The relationship between a recent period and higher detection rates of pSLs and SSLs was also demonstrated.
Lesion detectability in SCREESCO was mostly acceptable with room for improvement. In addition to sufficient withdrawal time, antispasmodic use and acquiring skills enabling short insertion time may improve lesion detection.
ClinicalTrials.gov, ID: NCT02078804.
结肠镜检查质量，包括病变可检测性，存在差异，且影响病变检测的因素尚未完全明确。本研究在瑞典结肠癌筛查（SCREESCO）研究中调查了结肠镜检查期间的病变检测率及相关因素。
在对SCREESCO数据进行的横断面分析中，SCREESCO是一项针对60岁瑞典人群的大规模结直肠癌筛查随机对照试验，我们评估了结肠镜检查组和粪便免疫化学检测（FIT）组首次结肠镜检查的数据。
本研究纳入了16552名个体。结肠镜检查组和FIT组的腺瘤检出率分别为23.9%和37.8%。关于结肠镜检查操作，退镜时间≥6分钟与高级别腺瘤（校正比值比[AOR]2.474，95%置信区间[CI]1.295 - 4.723）、腺瘤（2.181，1.515 - 3.140）及近端锯齿状病变（pSLs）（1.713，1.007 - 2.915）的较高检出率相关。使用解痉药与这些病变及无蒂锯齿状病变（SSLs）的较高检出率相关（AOR，95%CI：分别为1.523，1.295 - 1.791；1.361，1.217 - 1.522；1.450，1.247 - 1.687；以及1.810，1.512 - 2.167）。插入时间>20分钟与腺瘤、pSLs及SSLs的较低检出率相关（AOR，95%CI：分别为0.753，0.639 - 0.887；0.640，0.495 - 0.828；以及0.704，0.518 - 0.955）。还证实了近期与pSLs和SSLs较高检出率之间的关系。
SCREESCO中的病变可检测性大多可以接受，但仍有改进空间。除了足够的退镜时间外，使用解痉药和掌握能实现短插入时间的技能可能会提高病变检测率。
ClinicalTrials.gov，标识符：NCT02078804。
