Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, Alberta, Canada.
Gastroenterology. 2024 Aug;167(3):560-590. doi: 10.1053/j.gastro.2024.03.018. Epub 2024 Mar 19.
BACKGROUND & AIMS: Significant variability exists in colonoscopy quality indicators, including adenoma detection rate (ADR). We synthesized evidence from randomized trials in a network meta-analysis on interventions to improve colonoscopy quality.
We included trials from database inceptions to September 25, 2023, of patients undergoing screening-related colonoscopy and presented efficacies of interventions within domains (periprocedural parameters, endoscopist-directed interventions, intraprocedural techniques, endoscopic technologies, distal attachment devices, and additive substances) compared to standard colonoscopy. The primary outcome was ADR. We used a Bayesian random-effects model using Markov-chain Monte Carlo simulation, with 10,000 burn-ins and 100,000 iterations. We calculated odds ratios with 95% credible intervals and present surface under the cumulative ranking (SUCRA) curves.
We included 124 trials evaluating 37 interventions for the primary outcome. Nine interventions resulted in statistically significant improvements in ADR compared to standard colonoscopy (9-minute withdrawal time, dual observation, water exchange, i-SCAN [Pentax Ltd], linked color imaging, computer-aided detection, Endocuff [Olympus Corp], Endocuff Vision [Olympus Corp], and oral methylene blue). Dual observation (SUCRA, 0.84) and water exchange (SUCRA, 0.78) ranked highest among intraprocedural techniques; i-SCAN (SUCRA, 0.95), linked color imaging (SUCRA, 0.85), and computer-aided detection (SUCRA, 0.78) among endoscopic technologies; WingCap (A&A Medical Supply LLC) (SUCRA, 0.87) and Endocuff (SUCRA, 0.85) among distal attachment devices and oral methylene blue (SUCRA, 0.94) among additive substances. No interventions improved detection of advanced adenomas, and only narrow-band imaging improved detection of serrated lesions (odds ratio, 2.94; 95% credible interval, 1.46-6.25).
Several interventions are effective in improving adenoma detection and overall colonoscopy quality, many of which are cost-free. These results can inform endoscopists, unit managers, and endoscopy societies on relative efficacies.
结直肠镜检查质量指标存在显著差异，包括腺瘤检出率（ADR）。我们通过网络荟萃分析综合了随机试验证据，评估了改善结直肠镜检查质量的干预措施。
我们纳入了从数据库创建到 2023 年 9 月 25 日期间接受筛查相关结肠镜检查的患者的试验，并在各个领域（围手术期参数、内镜医师指导的干预措施、术中技术、内镜技术、远端附件装置和附加物质）内比较了干预措施与标准结肠镜检查的疗效。主要结局为 ADR。我们使用贝叶斯随机效应模型，采用马尔可夫链蒙特卡罗模拟，设有 10000 次预热和 100000 次迭代。我们计算了比值比及其 95%可信区间，并展示了累积排序曲线下面积（SUCRA）。
我们纳入了 124 项试验，评估了 37 种干预措施对主要结局的影响。9 种干预措施与标准结肠镜检查相比，ADR 有统计学意义的提高（9 分钟退镜时间、双重视觉、水交换、i-SCAN [Pentax Ltd]、链接颜色成像、计算机辅助检测、Endocuff [Olympus Corp]、Endocuff Vision [Olympus Corp] 和口服亚甲蓝）。双重视觉（SUCRA，0.84）和水交换（SUCRA，0.78）在术中技术中排名最高；i-SCAN（SUCRA，0.95）、链接颜色成像（SUCRA，0.85）和计算机辅助检测（SUCRA，0.78）在内镜技术中排名最高；WingCap（A&A Medical Supply LLC）（SUCRA，0.87）和 Endocuff（SUCRA，0.85）在远端附件装置中排名最高，口服亚甲蓝（SUCRA，0.94）在附加物质中排名最高。没有干预措施能提高高级腺瘤的检出率，只有窄带成像能提高锯齿状病变的检出率（比值比，2.94；95%可信区间，1.46-6.25）。
几种干预措施能有效提高腺瘤检出率和整体结直肠镜检查质量，其中许多是免费的。这些结果可以为内镜医师、单位管理人员和内镜学会提供相对疗效信息。
