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结肠镜筛查过程中经验丰富的内镜护士的参与可以增加结肠息肉的检出率:一项多中心前瞻性随机研究

发布日期:2014-1-29 12:40:23 文章来源:GIE 作者次数:1184
    结肠镜筛查过程中经验丰富的内镜护士的参与可以增加结肠息肉的检出率:一项多中心前瞻性随机研究
     
    背景
    目前还未有前瞻性的随机研究报告来评估作为辅助观察员的内镜护士参与结肠镜检的影响。
     
    目的
    确定在结肠镜检筛查过程中,是否内镜护士的参与提高了息肉的检出率(PDR)和腺瘤的检出率(ADR)。
     
    设计
    多中心,前瞻性,随机研究。
     
    环境
    学术医院。
     
    患者
    共有844例患者接受结肠镜筛查。
     
    干预
    取出结肠镜过程中,仅由结肠镜师组成的单一观察组和由结肠镜师与内镜护士组成双重观察组。
     
    主要结果测量
    息肉的检出率和腺瘤的检出率。
     
    结果
    在仅由內镜师组成的单一组和由內镜师与內镜护士组成的双重组中,在病人的人口统计数据,肠道准备充足性及平均收镜时间方面没有显著差别。791例患共有1153处息肉,其中包括762处腺瘤。有7处非息肉状的凹陷性肿瘤病变只在(0 IIC或联合类型)双重观察组中被检测出。多变量分析显示:与那些仅由结肠镜师组成的单一观察组相比,有经验丰富(≥2年)的内镜护士参与显著增加了息肉的检出率和腺瘤的检出率(调整后的比值比[OR]为1.58 [95%可信区间为1.07-2.32];调整比值比 1.47 [95%可信区间,1.01-2.12],)。此外与单一观察组相比,由一位有经验的内镜护士和內镜师们(不到500结肠镜检查)组成的双重观察组中息肉检出率更高(调整后OR为2.07 [95%CI为1.15-3.74])。然而与经验丰富內镜师参与的小组相比,经验丰富的护士参与组没有显现显著好处。
     
    局限性
    缺少无经验的结肠镜检查师。
     
    结论
    经验丰富内镜护士参与结肠镜筛查增加了息肉的检出率和腺瘤的检出率。然而,看上去只有在与完全没有结肠镜检查经验的內镜师一起参与下,经验丰富的护士参与的好处才能显现。 (临床试验,注册号:NCT01124266)。
     
    缩写词:ADR, 腺瘤检出率;HD,高清晰度;OR,比值比;PDR,息肉的检测率;SD,标准偏差
     
     
     
     
    Participation by experienced endoscopy nurses increases the detection rate of colon polyps during a screening colonoscopy: a multicenter, prospective, randomized study
    Background
    No reported prospective, randomized study has evaluated the impact of an endoscopy nurse participating as a second observer during colonoscopy.
    Objective
    To determine whether the participation of an endoscopy nurse enhanced the polyp detection rate (PDR) and adenoma detection rate (ADR) during screening colonoscopy.
    Design
    Multicenter, prospective, randomized study.
    Setting
    Academic hospitals.
    Patients
    A total of 844 consecutive patients undergoing screening colonoscopy.
    Interventions
    Single observation by colonoscopist or dual observation by colonoscopist and endoscopy nurse during colonoscope withdrawal.
    Main Outcome Measurements
    PDR and ADR.
    Results
    No significant difference in patient demographic data, adequacy of bowel preparation, or mean withdrawal time was observed between the 2 groups. In total, 1153 polyps, including 762 adenomas, were detected in 791 patients. Seven nonpolypoid, depressed neoplastic lesions (0-IIc or combined types) were only detected in the dual observation group. A multivariate analysis revealed that experienced (≥2 years) endoscopy nurse participation significantly increased the PDR and ADR compared with those in the single observation group by a colonoscopist alone (adjusted odds ratio [OR] 1.58 [95% CI, 1.07-2.32]; adjusted OR 1.47 [95% CI, 1.01-2.12], respectively). Additionally, the PDR was significantly higher in the dual-observation group with fellows (<500 colonoscopies) and an experienced endoscopy nurse versus that in the single observation group (adjusted OR 2.07 [95% CI, 1.15-3.74]). There was no significant benefit of experienced nurse participation in the subgroup with experienced colonoscopists.
    Limitations
    Absence of colonoscopist blinding.
    Conclusions
    Experienced endoscopy nurse participation increased the PDR and ADR during screening colonoscopy. However, the benefit of participation by experienced nurses appears to be exclusively with inexperienced colonoscopists. (Clinical trial registration number: NCT01124266.)
     
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