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大肠镜撤除技术水平和腺瘤检出率浮动性

发布日期:2014-1-29 12:40:14 文章来源:GIE(July,2011) 作者次数:1198

    大肠镜撤除技术水平和腺瘤检出率浮动性

    背景
    研究显示內镜师相关因素,比如大肠镜退镜技术是确定腺瘤检出率(ADR)的重要因素。
    目的
    为确定具有不同ADRs內镜师的撤退技术的重要性,这个技术为划分內镜师等级提供标准。
    设计方案
    前瞻性,多中心研究。
    环境
    五所学术性三级医疗中心(Five academic tertiary-care medical centers)
    患者
    此项研究包括11位胃肠病界內镜师。
    干预
    回顾研究11位內镜师结肠镜筛检情况,将他们分为低,中,高腺瘤检出率(ADR)三组。为每位內镜师随机录制20个(10个真实的,10个虚假的)撤除实例的影像记录,这20个撤除实例是为平均风险结肠癌筛检实施的结肠镜检查。三位事先不知情审查者对110个影响记录评定其撤除技术得分(共75分)。还有一位审查者单独记录撤出时间。
    主要评价指标
    撤除技术得分和撤出时间
    结果
    高、中、低三组撤除技术得分分别为59.5 ± 3,62 ± 2.5,40.8±3.中和高ADR组平均(±标准偏差[SD])得分比低ADR组高。低中高三组平均(± SD)撤除时间为6.3 ± 1.8分,10.2 ± 1.5分,8.2 ± 1.8分(P = 0.29)。比较最低与最高ADRs这两组独立內镜师撤除时间和技术得分,我们发现撤除时间无显著差异,分别为6.6 ± 1.7分,7.4 ± 1.7分(P =0.36);但技术得分有将近2倍的差异,分别为36.2±9,62.8±9.9(P=0.0001)。
    局限性
    没有充分的?检测出撤除时间的微小差异。
    结论
    撤除技术是区分不同ADRs內镜师能力的一个重要指标。在确定ADRs方面撤除技术若不是比撤除时间更重要,也至少和它一样重要。
     
    缩写: ADR为腺瘤检出率,CQI为持续性质量改进
     
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    Quality of colonoscopy withdrawal technique and variability in adenoma detection rates

    Background
    Studies suggest that endoscopist-related factors such as colonoscopy withdrawal time are important in determining the adenoma detection rate (ADR).
    Objective
    To determine the importance of withdrawal technique in differentiating among endoscopists with varying ADRs.
    Design
    Prospective, multicenter study.
    Setting
    Five academic tertiary-care medical centers.
    Participants
    This study involved 11 gastroenterology faculty endoscopists.
    Intervention
    A retrospective review of screening colonoscopies was performed to categorize endoscopists into low, moderate, and high ADR groups. Video recordings were randomly obtained for each endoscopist on 20 (10 real, 10 sham) withdrawals during colonoscopies performed for average-risk colorectal cancer screening. Three blinded reviewers assigned withdrawal technique scores (total of 75 points) on 110 video recordings. A separate reviewer recorded withdrawal times.
    Main Outcome Measurements
    Withdrawal technique scores and withdrawal times.
    Results
    Mean (± standard deviation [SD]) withdrawal technique scores were higher in the moderate (62 ± 2.5) and high (59.5 ± 3) ADR groups compared with the low (40.8±3) ADR group (P = .002). Mean (± SD) withdrawal times were 6.3 ± 1.8 minutes (low ADR), 10.2 ± 1.5 minutes (moderate ADR), and 8.2 ± 1.8 minutes (high ADR) (P = .29). A comparison of the withdrawal times and technique scores of the two individual endoscopists with the lowest and highest ADRs did not find a significant difference in withdrawal times (6.6 ± 1.7 vs 7.4 ± 1.7 minutes) (P = .36) but did find a nearly 2-fold difference in technique scores (36.2 ± 9 vs 62.8 ± 9.9) (P = .0001).
    Limitations
    Not adequately powered to detect small differences in withdrawal times.
    Conclusion
    Withdrawal technique is an important indicator that differentiates between endoscopists with varying ADRs. It is possible that withdrawal technique is equal to, if not more important than, withdrawal time in determining ADRs.
     
     
     
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