Department of Gastroenterology, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, ISABIAL, Alicante, Spain.
Department of Gastroenterology, Parc de Salut Mar, Hospital del Mar, Barcelona, Spain.
United European Gastroenterol J. 2022 Nov;10(9):1008-1019. doi: 10.1002/ueg2.12325. Epub 2022 Oct 27.
Different factors may influence colonoscopy performance measures. We aimed to analyze procedure- and endoscopist-related factors associated with detection of colorectal lesions and whether these factors have a similar influence in the context of different colonoscopy indications: positive fecal immunochemical test (+FIT) and post-polypectomy surveillance colonoscopies.
This multicenter cross-sectional study included adults aged 40-80 years. Endoscopists (N = 96) who had performed ≥50 examinations were assessed for physician-related factors. Adenoma detection rate (ADR), adenomas per colonoscopy rate (APCR), advanced ADR, serrated polyp detection (SDR), and serrated polyps per colonoscopy rate (SPPCR) were calculated.
We included 12,932 procedures, with 4810 carried out after a positive FIT and 1967 for surveillance. Of the 96 endoscopists evaluated, 43.8% were women, and the mean age was 41.9 years. The ADR, advanced ADR, and SDR were 39.7%, 17.7%, and 12.8%, respectively. Adenoma detection rate was higher in colonoscopies after a +FIT (50.3%) with a more than doubled advanced ADR compared to non-FIT procedures (27.6% vs. 13.0%) and similar results in serrated lesions (14.7% vs. 13.5%). Among all the detection indicators analyzed, withdrawal time was the only factor independently related to improvement (p < 0.001). Regarding FIT-positive and surveillance procedures, for both indications, withdrawal time was also the only factor associated with a higher detection of adenomas and serrated polyps (p < 0.001). Endoscopist-related factors (i.e., weekly hours dedicated to endoscopy, annual colonoscopy volume and lifetime number of colonoscopies performed) had also impact on lesion detection (APCR, advanced ADR and SPPCR).
Withdrawal time was the factor most commonly associated with improved detection of colonic lesions globally and in endoscopies for + FIT and post-polypectomy surveillance. Physician-related factors may help to address strategies to support training and service provision. Our results can be used for establishing future benchmarking and quality improvement in different colonoscopy indications.
不同因素可能会影响结肠镜检查的绩效指标。本研究旨在分析与操作过程和内镜医生相关的因素与结直肠病变检出率的相关性，并探讨这些因素在不同结肠镜检查适应证（粪便免疫化学检测阳性（+FIT）和息肉切除术后监测结肠镜检查）中的影响是否具有相似性。
这是一项多中心的横断面研究，纳入了年龄在 40-80 岁之间的成年人。评估了 96 名内镜医生的医生相关因素，这些内镜医生进行的结肠镜检查数量≥50 例。计算了腺瘤检出率（ADR）、每例结肠镜检查检出的腺瘤数（APCR）、高级别 ADR、锯齿状息肉检出率（SDR）和每例结肠镜检查检出的锯齿状息肉数（SPPCR）。
共纳入 12932 例操作，其中 4810 例在+FIT 后进行，1967 例用于监测。在评估的 96 名内镜医生中，43.8%为女性，平均年龄为 41.9 岁。ADR、高级别 ADR 和 SDR 分别为 39.7%、17.7%和 12.8%。在+FIT 后进行的结肠镜检查中，ADR 更高（50.3%），与非-FIT 操作相比，高级别 ADR 增加了一倍以上（27.6% vs. 13.0%），锯齿状病变的结果也相似（14.7% vs. 13.5%）。在分析的所有检测指标中，退镜时间是唯一与改善相关的因素（p<0.001）。对于 FIT 阳性和监测操作，对于这两种适应证，退镜时间也是与腺瘤和锯齿状息肉检出率更高相关的唯一因素（p<0.001）。内镜医生相关因素（即每周用于内镜的时间、每年结肠镜检查量和一生中进行的结肠镜检查次数）也与病变检出率（APCR、高级别 ADR 和 SPPCR）相关。
退镜时间是全球范围内以及在+FIT 和息肉切除术后监测结肠镜检查中与结直肠病变检出率提高最相关的因素。医生相关因素可能有助于制定支持培训和服务提供的策略。我们的研究结果可用于在不同的结肠镜检查适应证中建立未来的基准和质量改进。
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