Choi Ji Min, Lim Seon Hee, Han Yoo Min, Lee Jooyoung, Jin Eun Hyo, Seo Ji Yeon, Kim Jung
Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul 06236, Republic of Korea.
J Clin Med. 2024 Nov 23;13(23):7080. doi: 10.3390/jcm13237080.
A longer cecal intubation time (CIT) occurs during colonoscopy under difficult insertion conditions, which may hinder meticulous mucosal observation. However, whether a longer CIT has detrimental effects on the detection of adenomas remains unclear. We evaluated the effects of CIT on the detection and miss rates of colorectal neoplasms in asymptomatic participants. Healthy examinees who underwent colonoscopy between March and July 2011, August 2015, and December 2016 were retrospectively enrolled. The primary outcome was the adenoma detection rate (ADR) across CIT quartiles, while the secondary outcomes included the mean number of adenomas, advanced ADR (AADR), clinically significant serrated lesion (CSSP) detection, adenoma miss rate (AMR), miss rate of CSSPs and any colorectal neoplasms, and the mean number of missed colorectal neoplasms in relation to CIT. Overall, 12,402 participants were classified into quartiles according to the CIT. The longer the CIT, the lower the ADR ( < 0.001), AADR ( = 0.004), and mean number of adenomas ( < 0.001). The CSSP detection rate was not associated with CIT. On follow-up colonoscopy, AMR showed marginal increase with longer CIT ( = 0.065). The missed rates of CSSPs ( = 0.002) and colorectal neoplasms ( = 0.001) also increased with longer CIT. In the multivariate analysis, CIT was significantly associated with ADR, AADR, and AMR. Longer CIT was associated with lower ADR and higher AMR. Meticulous inspection is important for high-quality colonoscopy, particularly in patients requiring a longer CIT.
在插入困难的结肠镜检查过程中，盲肠插管时间（CIT）会延长，这可能会妨碍对黏膜的细致观察。然而，较长的CIT是否会对腺瘤的检测产生不利影响仍不清楚。我们评估了CIT对无症状参与者结直肠肿瘤检测率和漏诊率的影响。回顾性纳入了2011年3月至7月、2015年8月和2016年12月期间接受结肠镜检查的健康受检者。主要结局是各CIT四分位数的腺瘤检测率（ADR），次要结局包括腺瘤的平均数量、进展期腺瘤检测率（AADR）、临床显著锯齿状病变（CSSP）的检测、腺瘤漏诊率（AMR）、CSSP和任何结直肠肿瘤的漏诊率，以及与CIT相关的结直肠肿瘤漏诊的平均数量。总体而言，12402名参与者根据CIT被分为四分位数。CIT越长，ADR（<0.001）、AADR（=0.004）和腺瘤平均数量（<0.001）越低。CSSP检测率与CIT无关。在随访结肠镜检查中，AMR随着CIT延长呈边缘性增加（=0.065）。CSSP（=0.002）和结直肠肿瘤（=0.001）的漏诊率也随着CIT延长而增加。在多变量分析中，CIT与ADR、AADR和AMR显著相关。较长的CIT与较低的ADR和较高的AMR相关。细致检查对于高质量结肠镜检查很重要，特别是对于需要较长CIT的患者。
