设为首页 | 加入收藏
| 欢迎光临本站!

消化内镜学分会官方网站

当前位置:文献追踪 > 国内外期刊

撤镜时间作为结肠镜检查的一个质量指标:一项全国性分析

发布日期:2014-1-29 12:40:45 文章来源:ENDOSCOPY 作者次数:1563
    撤镜时间作为结肠镜检查的一个质量指标:一项全国性分析

    V. Moritz1, 2, M. Bretthauer2, 3, 4, H. K. Ruud5, T. Glomsaker6, T. de Lange7, P. Sandvei8, G. Huppertz-Hauss1, Ø. Kjellevold9, G. Hoff1, 2, 3

    1挪威希恩泰勒马克医院医学部

    2挪威Gastronet 质量保证计划

    3挪威奥斯陆癌症登记处

    4挪威奥斯陆大学国家医院肠胃科

    5挪威奥斯陆大学和挪威东南部地区卫生局研究中心

    6挪威斯塔万格大学医院外科

    7挪威贝鲁姆Vestre Viken医院医学部

    8挪威费德列斯达和萨普斯堡医学部

    9克拉格勒 Telemark医院医学部

    背景与研究目的:目前人们推荐至少6分钟的撤镜时间可作为结肠镜检查的质量指标。有许多研究已经对撤镜时间进行了研究,但所得出的结果互相冲突,这些研究的其中一个缺点就是其是单中心设计,且有较少的内镜师参与。因此,目前关于撤镜时间作为质量指标的有效性仍不明确。本研究旨在探讨在全国性分析中个别撤镜时间的重要性。

    患者和方法:本前瞻性队列研究包含自20091月至9月在19所挪威中心接受结肠镜检查和在挪威Gastronet质量保证计划(QA)进行登记的门诊患者的资料。通过可视结肠镜检查(无活检或治疗的诊断学结肠镜检查)的中位撤镜时间,对参与结肠镜检查的内镜师进行表征,并将这些内镜师分为两个可视撤镜时间(VWT)组(< 6 分钟或 ≥ 6 分钟),以采用多因素Logistic回归模型分析一个或多个诊断直径≥ 5毫米的息肉的VWT预测值。

    结果:本研究包括4429个由内镜师实施的连续结肠镜检查。对检测 ≥ 5 毫米的息肉来说,中位VWT ≥ 6分钟与< 6分钟的内镜师相比,调整后的比值比为1.2195%置信区间CI0.94 - 1.56P = 0.14)。

    结论6分钟的撤镜时间极值不是一个在结肠镜检查过程中预测息肉存在可能性的有力指标,而且它也不应用作结肠镜检查的质量指标。

     


     

    Withdrawal time as a quality indicator for colonoscopy - a nationwide analysis

    V. Moritz1, 2, M. Bretthauer2, 3, 4, H. K. Ruud5, T. Glomsaker6, T. de Lange7, P. Sandvei8, G. Huppertz-Hauss1, Ø. Kjellevold9, G. Hoff1, 2, 3

    1Department of Medicine, TelemarkHospital,Skien,Norway

    2Gastronet Quality AssuranceProgram,Norway

    3Cancer Registry,Oslo,Norway

    4Department of Gastroenterology,OsloUniversityHospitalRikshospitalet,Oslo,Norway

    5Research Centre,UniversityofOsloand South-East Regional Health Board,Oslo,Norway

    6Department of Surgery,StavangerUniversityHospital,Stavanger,Norway

    7Department of Medicine,VestreVikenHospital,Bærum,Norway

    8Department of Medicine,ØstfoldHospital, Frederikstad andSarpsborg,Norway

    9Department of Medicine,TelemarkHospital, Kragerø

    Background and study aims: A withdrawal time of at least 6 min has been recommended as a quality indicator for colonoscopy. One drawback of many of the studies that have investigated withdrawal time and produced conflicting results has been their single-center design involving few endoscopists. Therefore, the validity of withdrawal time as a quality measure remains unclear. This study explores the value of individual withdrawal time in a nationwide analysis.

    Patients and methods: This prospective cohort study comprised data from outpatient colonoscopies performed at 19 Norwegian centers from January to September 2009 and registered in the Norwegian Gastronet Quality Assurance (QA) program. The participating endoscopists were characterized by their median withdrawal time for visual colonoscopies (diagnostic colonoscopies without biopsy or therapy) and categorized into two visual withdrawal time (VWT) groups (< 6 min or ≥ 6 min) to analyze the predictive value of VWT for detection of one or more polyps ≥5 mmin diameter using multiple logistic regression models.

    Results: The study included 4429 consecutive colonoscopies performed by 67 endoscopists. The adjusted odds ratio for the detection of polyps ≥5 mmwas 1.21 (95 %CI 0.94 - 1.56, P = 0.14) for endoscopists with a median VWT ≥ 6 min compared with endoscopists with a median VWT < 6 min.

    Conclusion: Withdrawal time using 6 min as the threshold is not a strong predictor of the likelihood of finding a polyp during colonoscopy and should not be used as a quality indicator.

     

    (作者:)
相关评论
用户名: 登录