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在背对背式结肠镜研究中息肉漏诊率的影响因素

发布日期:2014-1-29 12:40:45 文章来源:ENDOSCOPY 作者次数:1254
    在背对背式结肠镜研究中息肉漏诊率的影响因素

    A. M. Leufkens, M. G. H. van Oijen, F. P. Vleggaar, P. D. Siersema, *

    荷兰乌得勒支大学医学中心胃肠病肝病科

    背景与研究目的:在接受结肠镜检查的患者中,22%-28%的息肉和20 % - 24 %的腺瘤被漏诊。目前还不清楚导致息肉漏诊的因素,但是如果在结肠镜检查后3年内检出大肠癌,那么它可能起源于漏诊的病变。本研究旨在确定结肠镜检查期间与患者和息肉相关的息肉和腺瘤漏诊的影响因素。

    患者和方法:从一项多中心随机背对背式结肠镜检查研究中获得406例患者资料,该项研究审查了第三只眼反转内镜通过可视化隐蔽部位(如褶皱和弯曲处)来改善息肉检出率的情况。将患者随机分配,让他们接受标准结肠镜检查,之后接受带TER的结肠镜检查,或反之亦然。然后计算所有息肉和腺瘤的漏诊率。按结肠/直肠内的所有病变尺寸和位置,对这些病变进行归类。采用调整的逻辑回归模型计算比值比(ORs),以确定与漏诊率独立相关的因素。

    结果:对所有息肉的漏诊率为25%150 /611),同时对所有腺瘤的漏诊率为26 % 90 /350)。对随机分配到TER(作为第一道手术)的患者来说,其漏诊率显著低于先接受标准结肠镜检查的患者,二者漏诊率分别为21%29%P < 0.03)。综合各组,在第一次结肠镜检出期间,与检出 ≤2处息肉相比, >2处息肉增加了其它息肉的漏诊风险(调整后的比值比为2.8395%置信区间[CI]1.22 - 6.70)。与右半结肠腺瘤相比,左半结肠腺瘤的漏诊风险也更常见(调整后的比值比为1.6595 %置信区间为1.06 - 2.58)。

    结论:在结肠镜检出期间,有四分之一的息肉被漏诊。医师们应清楚地知道息肉漏诊风险与患者因素(存在2处以上息肉)和息肉因素(左半结肠位置)相关。

     


    Factors influencing the miss rate of polyps in a back-to-back colonoscopy study

    A. M. Leufkens, M. G. H. van Oijen, F. P. Vleggaar, P. D. Siersema, *

    Department of Gastroenterology and Hepatology, UniversityMedicalCenterUtrecht,Utrecht, TheNetherlands

    Background and study aims: In patients undergoing colonoscopy, 22 % - 28 % of polyps and 20 % - 24 % of adenomas are missed. It is unclear which factors contribute to polyp miss rates, but colorectal cancer detected within 3 years after colonoscopy may originate from missed lesions. The aim of the current study was to determine patient- and polyp-related factors that influence the miss rates of polyps and adenomas during colonoscopy.

    Patients and methods: Data from 406 patients were obtained from a multicenter, randomized back-to-back colonoscopy study investigating the Third Eye Retroscope (TER) in improving polyp detection rate by visualizing hidden areas such as folds and curves. Patients were randomized to undergo standard colonoscopy followed by colonoscopy with TER, or vice versa. Miss rates were calculated for all polyps and adenomas. All lesions were categorized for size and location within the colon/rectum. Odds ratios (ORs) were computed using adjusted logistic regression models to identify factors independently associated with missed lesions.

    Results: The miss rate was 25 % (150 /611) for all polyps and 26 % (90 /350) for adenomas. Miss rates were significantly lower (21 % vs. 29 %) in patients randomized to TER as the first procedure (P < 0.03). Taking all groups together, > 2 polyps compared with ≤ 2 polyps detected during the first colonoscopy increased the risk of missing additional polyps (adjusted OR = 2.83; 95 % confidence interval [CI] 1.22 - 6.70). Adenomas in the left colon compared with adenomas in the right colon were also more frequently missed (adjusted OR = 1.65; 95 %CI 1.06 - 2.58).

    Conclusions: A quarter of polyps were missed during colonoscopy. Physicians should be aware that the risk of missing a polyp is related to patient factors (presence of > 2 polyps) and polyp factors (left colon location).

     

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