Digestive Endoscopy Center, Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China.
National Digestive Endoscopy Improvement System, Shanghai, China.
Clin Transl Gastroenterol. 2023 Aug 1;14(8):e00612. doi: 10.14309/ctg.0000000000000612.
Positive correlation between examination time and neoplasm detection using esophagogastroduodenoscopy (EGD) has been described by observational studies, but the effect of setting minimal examination time still requires investigation.
This prospective, 2-stage, interventional study was conducted in 7 tertiary hospitals in China, enrolling consecutive patients undergoing intravenously sedated diagnostic EGDs. In stage I, the baseline examination time was collected without informing the endoscopists. In stage II, the minimal examination time was set for the same endoscopist according to the median examination time of normal EGDs in stage I. The primary outcome was the focal lesion detection rate (FDR), defined as the proportion of subjects with at least one focal lesion among all subjects.
A total of 847 and 1,079 EGDs performed by 21 endoscopists were included in stages I and II, respectively. In stage II, the minimal examination time was set as 6 minutes, and the median time for normal EGD increased from 5.8 to 6.3 minutes ( P < 0.001). Between the 2 stages, the FDR was significantly improved (33.6% vs 39.3%, P = 0.011), and the effect of the intervention was significant (odds ratio, 1.25; 95% confidence interval, 1.03-1.52; P = 0.022) even after adjusting for subjects' age, smoking status, endoscopists' baseline examination time, and working experience. The detection rate of high-risk lesions (neoplastic lesions and advanced atrophic gastritis) was also significantly higher in stage II (3.3% vs 5.4%, P = 0.029). In the endoscopist-level analysis, all practitioners reached a median examination time of 6 minutes, and the coefficients of variation of FDR (36.9%-26.2%) and examination time (19.6%-6.9%) decreased in stage II.
Setting a 6-minute minimal examination time significantly improved the detection of focal lesions during EGDs and has the potential to be implemented for quality improvement.
观察性研究表明，食管胃十二指肠镜检查（EGD）的检查时间与肿瘤检出率呈正相关，但设定最小检查时间的效果仍需研究。
本前瞻性、两阶段、干预性研究在中国 7 家三级医院进行，纳入接受静脉镇静诊断性 EGD 的连续患者。在第一阶段，在不告知内镜医生的情况下收集基线检查时间。在第二阶段，根据第一阶段正常 EGD 检查时间的中位数，为同一位内镜医生设定最小检查时间。主要结局是局灶性病变检出率（FDR），定义为所有患者中至少有一个局灶性病变的患者比例。
共有 21 名内镜医生分别在第一阶段和第二阶段进行了 847 次和 1079 次 EGD。在第二阶段，最小检查时间设定为 6 分钟，正常 EGD 的中位时间从 5.8 分钟增加到 6.3 分钟（P<0.001）。在两个阶段之间，FDR 显著提高（33.6%比 39.3%，P=0.011），即使在调整了患者年龄、吸烟状况、内镜医生基线检查时间和工作经验后，干预效果仍然显著（比值比，1.25；95%置信区间，1.03-1.52；P=0.022）。第二阶段高危病变（肿瘤性病变和高级萎缩性胃炎）的检出率也显著升高（3.3%比 5.4%，P=0.029）。在内镜医生水平分析中，所有医生的中位检查时间均达到 6 分钟，第二阶段 FDR（36.9%-26.2%）和检查时间（19.6%-6.9%）的变异系数降低。
设定 6 分钟的最小检查时间可显著提高 EGD 时局灶性病变的检出率，有可能用于质量改进。
