Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway.
Clinical Effectiveness Research Group, Oslo University Hospital, Oslo, Norway.
Gut. 2023 May;72(5):951-957. doi: 10.1136/gutjnl-2022-327696. Epub 2022 Oct 28.
High-quality colonoscopy (adequate bowel preparation, whole-colon visualisation and removal of all neoplastic polyps) is a prerequisite to start polyp surveillance, and is ideally achieved in one colonoscopy. In a large multinational polyp surveillance trial, we aimed to investigate clinical practice variation in number of colonoscopies needed to enrol patients with low-risk and high-risk adenomas in polyp surveillance.
We retrieved data of all patients with low-risk adenomas (one or two tubular adenomas <10 mm with low-grade dysplasia) and high-risk adenomas (3-10 adenomas, ≥1 adenoma ≥10 mm, high-grade dysplasia or villous components) in the European Polyp Surveillance trials fulfilling certain logistic and methodologic criteria. We analysed variations in number of colonoscopies needed to achieve high-quality colonoscopy and enter polyp surveillance by endoscopy centre, and by endoscopists who enrolled ≥30 patients.
The study comprised 15 581 patients from 38 endoscopy centres in five European countries; 6794 patients had low-risk and 8787 had high-risk adenomas. 961 patients (6.2%, 95% CI 5.8% to 6.6%) underwent two or more colonoscopies before surveillance began; 101 (1.5%, 95% CI 1.2% to 1.8%) in the low-risk group and 860 (9.8%, 95% CI 9.2% to 10.4%) in the high-risk group. Main reasons were poor bowel preparation (21.3%) or incomplete colonoscopy/polypectomy (14.4%) or planned second procedure (27.8%). Need of repeat colonoscopy varied between study centres ranging from 0% to 11.8% in low-risk adenoma patients and from 0% to 63.9% in high-risk adenoma patients. On the second colonoscopy, the two most common reasons for a repeat (third) colonoscopy were piecemeal resection (26.5%) and unspecified reason (23.9%).
There is considerable practice variation in the number of colonoscopies performed to achieve complete polyp removal, indicating need for targeted quality improvement to reduce patient burden.
NCT02319928.
高质量的结肠镜检查（充分的肠道准备、全结肠可视化和切除所有肿瘤性息肉）是开始息肉监测的前提条件，理想情况下可在一次结肠镜检查中实现。在一项大型跨国息肉监测试验中，我们旨在研究在低危腺瘤和高危腺瘤患者中进行息肉监测所需的结肠镜检查次数的临床实践差异。
我们检索了符合某些逻辑和方法学标准的欧洲息肉监测试验中所有低危腺瘤（管状腺瘤<10mm，低级别异型增生，一个或两个）和高危腺瘤（3-10 个腺瘤，≥1 个≥10mm 的腺瘤，高级别异型增生或绒毛成分）患者的数据。我们分析了内镜中心和入组≥30 例患者的内镜医生在实现高质量结肠镜检查和内镜下息肉监测方面所需结肠镜检查次数的差异。
这项研究纳入了来自五个欧洲国家 38 个内镜中心的 15581 例患者；6794 例患者患有低危腺瘤，8787 例患者患有高危腺瘤。961 例（6.2%，95%CI 5.8%至 6.6%）患者在开始监测前接受了两次或更多次结肠镜检查；低危组 101 例（1.5%，95%CI 1.2%至 1.8%），高危组 860 例（9.8%，95%CI 9.2%至 10.4%）。主要原因是肠道准备不佳（21.3%）、结肠镜检查不完全/息肉切除术不完整（14.4%）或计划行第二次手术（27.8%）。在低危腺瘤患者中，需要重复结肠镜检查的研究中心差异很大，从 0%至 11.8%不等，在高危腺瘤患者中，从 0%至 63.9%不等。在第二次结肠镜检查中，再次（第三次）结肠镜检查的两个最常见原因是分片切除（26.5%）和未指定原因（23.9%）。
为了实现完全切除息肉，需要进行多次结肠镜检查，这表明需要进行有针对性的质量改进，以减轻患者负担。
NCT02319928。
