Sui Yue, Zheng Yanhua, Wang Qing, Lv Jieping, Wang Hongjin, Wen Qing, Wang Zhenzhen, Wang Guanfeng, Jia Hui, Cao Fengzhen, Wang Naping, Hao Junlian, Zhang Yiping, Wu Xiaopeng, Chen Haihua, Lu Junhui, Chen Xing
Shanxi Medical University, 030000, China.
Shanxi Medical University, 030000, China.
Eur J Intern Med. 2023 Apr;110:48-53. doi: 10.1016/j.ejim.2023.01.019. Epub 2023 Jan 27.
Deep-sedated colonoscopy with propofol is widely used in China. However, its impact on quality metrics remains controversial. We aimed to investigate the effects of deep-sedated colonoscopy on missed adenomas, specifically in each colorectal segment.
Data of 3710 individuals from seven hospitals in China who underwent an initial colonoscopy with or without propofol sedation and a second colonoscopy without sedation within six months for surveillance or polypectomy by endoscopist of the same level between October 2020 and September 2021 were retrospectively analyzed.
A total of 1113 missed adenomas in 3710 patients were evaluated. The adenoma miss rate (AMR) was significantly higher in deep-sedated colonoscopy than in unsedated colonoscop [19.14% (578/3020) vs. 16.15% (535/3313), P < 0.05]. The risk of missing adenomas in deep-sedated colonoscopy was 1.229 times higher than in unsedated colonoscopy (OR, 1.229; 95% CI: 1.080-1.399). AMRs of the splenic flexure (26.02% [96/369] vs. 16.04% [47/293], P < 0.05) and descending colon (20.86% [102/489] vs. 13.37% [54/404], P < 0.05) were significantly higher in deep-sedated colonoscopy than in unsedated colonoscopy when performed by middle-level endoscopists rather than high-level endoscopists (P < 0.05).
AMR was higher in deep-sedated colonoscopy than in unsedated colonoscopy. Furthermore, adenomas in the splenic flexure and descending colon were more frequently missed in deep-sedated colonoscopy than in unsedated colonoscopy, particularly when performed by less experienced endoscopists.
在中国，丙泊酚深度镇静下的结肠镜检查被广泛应用。然而，其对质量指标的影响仍存在争议。我们旨在研究深度镇静结肠镜检查对漏诊腺瘤的影响，特别是在每个结直肠段。
回顾性分析了2020年10月至2021年9月期间，来自中国七家医院的3710例患者的数据，这些患者接受了首次结肠镜检查，检查时使用或未使用丙泊酚镇静，并且在六个月内由同一水平的内镜医师进行了第二次无镇静的结肠镜检查，用于监测或息肉切除。
对3710例患者中的1113例漏诊腺瘤进行了评估。深度镇静结肠镜检查的腺瘤漏诊率（AMR）显著高于未镇静结肠镜检查[19.14%（578/3020）对16.15%（535/3313），P<0.05]。深度镇静结肠镜检查漏诊腺瘤的风险比未镇静结肠镜检查高1.229倍（OR，1.229；95%CI：1.080-1.399）。当由中级内镜医师而非高级内镜医师进行检查时，深度镇静结肠镜检查中脾曲（26.02%[96/369]对16.04%[47/293]，P<0.05）和降结肠（20.86%[102/489]对13.37%[54/404]，P<0.05）的AMR显著高于未镇静结肠镜检查（P<0.05）。
深度镇静结肠镜检查的AMR高于未镇静结肠镜检查。此外，深度镇静结肠镜检查比未镇静结肠镜检查更频繁地漏诊脾曲和降结肠的腺瘤，尤其是在经验较少的内镜医师进行检查时。
