Macatiag Jonathan J, Mariño Bernadette Alexis M, Pajes A Nico Nahar I, Yasay Eric B
Department of Medicine, Philippine General Hospital, University of the Philippines Manila.
Division of Gastroenterology, Department of Medicine, Philippine General Hospital, University of the Philippines Manila.
Acta Med Philipp. 2024 Sep 13;58(16):30-41. doi: 10.47895/amp.vi0.8395. eCollection 2024.
Colorectal cancer (CRC) is the third most commonly diagnosed cancer and the fourth leading cause of cancer mortality worldwide. Likewise in the Philippines, the prevalence of CRC has shown to be increasing. Colonoscopy, a screening procedure for CRC, has parameters to gauge quality of detection. One of which is the Adenoma Detection Rate (ADR). Higher ADR has been linked to improved cancer detection. This study aimed to determine the ADR and Polyp Detection Rate (PDR) among Gastroenterology practitioners in a tertiary government university hospital in the Philippines, estimate ADR from PDR, and identify factors associated with ADR.
An analytical, cross-sectional study among patients who underwent colonoscopy for the years 2021 and the first half of 2022 at the Central Endoscopy Unit (CENDU) of the Philippine General Hospital. Demographic data of fellows and consultants were collected through an online form, while those from patients were obtained from electronic records. Colonoscopy details and histopathology results were accessed through the hospital's Open Medical Record System (MRS). ADR, PDR, and estimated ADR were computed using established formulas. To evaluate the strength of the relationship between the estimated and actual ADR, Pearson's correlation coefficient was used. Chi-square analysis, Mann-Whitney U test, and Kruskal-Wallis H test were performed to identify the factors that might influence the ADR. A cut-off of <0.05 was considered statistically significant.
The total computed ADR of consultants and fellows combined is 22%. The difference between the ADRs of Gastroenterology consultants and Fellows-in-Training is statistically significant at 31.6% and 18.7%, respectively (= 0.017). The total Polyp Detection Rate is 57.6% while the weighted group average Adenoma to Polyp Detection Rate Quotient (APDRQ) is 0.4085 or 40.85%. The estimated ADR has a moderate degree of correlation with the actual ADR when an outlier was excluded (r=0.521 (95% CI, 0.072-0.795, =0.0266). Significant factors related to ADR include endoscopists' years of practice (=0.020), number of colonoscopies done (=0.031), and patient tobacco use (=0.014).
The overall ADR among consultants and fellows is at par with the standard guidelines. A moderate degree of correlation exists between actual and estimated ADR when an outlier is excluded; however, more studies are needed to determine the APDRQ in the wider local setting. Longer years in practice, total number of colonoscopies performed, and patient tobacco use are associated with increased ADR.
结直肠癌（CRC）是全球第三大常见诊断癌症，也是第四大致癌死亡原因。同样在菲律宾，结直肠癌的患病率呈上升趋势。结肠镜检查作为结直肠癌的一种筛查方法，有衡量检测质量的参数。其中之一是腺瘤检出率（ADR）。较高的ADR与癌症检测改善相关。本研究旨在确定菲律宾一家三级政府大学医院的胃肠病学从业者的ADR和息肉检出率（PDR），从PDR估计ADR，并识别与ADR相关的因素。
对2021年及2022年上半年在菲律宾总医院中央内镜科（CENDU）接受结肠镜检查的患者进行一项分析性横断面研究。通过在线表格收集研究员和顾问的人口统计学数据，而患者的数据则从电子记录中获取。通过医院的开放式医疗记录系统（MRS）获取结肠镜检查细节和组织病理学结果。使用既定公式计算ADR、PDR和估计的ADR。为评估估计的ADR与实际ADR之间关系的强度，使用了Pearson相关系数。进行卡方分析、Mann-Whitney U检验和Kruskal-Wallis H检验以识别可能影响ADR的因素。截断值<0.05被认为具有统计学意义。
顾问和研究员的总计算ADR为22%。胃肠病学顾问和实习研究员的ADR差异具有统计学意义，分别为31.6%和18.7%（=0.017）。息肉总检出率为57.6%，而加权组平均腺瘤与息肉检出率商（APDRQ）为0.4085或40.85%。当排除一个异常值时，估计的ADR与实际ADR具有中等程度的相关性（r=0.521（95%CI，0.072-0.795，=0.0266）。与ADR相关的显著因素包括内镜医师的执业年限（=0.020）、结肠镜检查次数（=0.031）和患者吸烟情况（=0.014）。
顾问和研究员的总体ADR符合标准指南。当排除一个异常值时，实际ADR与估计ADR之间存在中等程度的相关性；然而，需要更多研究来确定更广泛本地环境中的APDRQ。更长的执业年限、进行的结肠镜检查总数以及患者吸烟情况与ADR增加相关。
