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采用全系统执行用于结肠镜检查的分剂量准备以增加腺瘤的检出率

发布日期:2014-1-29 12:40:54 文章来源:ENDOSCOPY 作者次数:1636
    采用全系统执行用于结肠镜检查的分剂量准备以增加腺瘤的检出率 

    背景

    最近,采用分剂量准备(SDPs)进行的研究表明,准备的质量和患者依存性得到显著的改善。然而,根据我们所知,SDP对其它的结肠镜检查质量指标的影响(如在盲肠插管和腺瘤的检出率方面)目前还没有相关报道。

    目的

    本研究的主要目的是比较SDP作为首选肠道准备实施前后的息肉检出率(PDRs)和腺瘤检出率(ADRs)。次要目标是比较SDP实施前后准备的质量和结肠镜检查的完成率。

    设计

    回顾性研究

    实验环境

    三级护理学术医疗中心

    患者

    进行肠息肉和癌症筛查和监测的肠镜检患者。

    干预

    SDP全系统的实施。

    结果

    这项研究包括3560例(SDP前患者组)和1615例(SDP后患者组)患者。实施后,SDP的使用从9%显著增加到了74%,与SDP前患者组相比,SDP后患者组PDRs (44.1%-49.5%P < 0.001) ADRs (26.7%-31.8%; P < 0.001)均显著增加。在SDP后患者组中,结肠镜检查完成率显著上升,从93.6%增加到95.5%P = 0.008),同时,该组肠道准备质量也显著提高(P < 0.001)。

    局限性

    回顾性设计;两个时期中并不是所有的内镜师都一样。

    结论

    全系统实施作为结肠镜检查主要选择的SDP可显著提高PDRs ADRs以及准备的整体质量和结肠镜检查完成率。

    缩写词ADR,腺瘤检出率;PDR,息肉检查率;PEG,聚乙二醇;SDP,分剂量准备;SSA,无蒂锯齿状腺瘤


     

    Increased adenoma detection rate with system-wide implementation of a split-dose preparation for colonoscopy

    Presented at American College of Gastroenterology annual meeting, Washington DC, October 28-November 2, 2011 (Am J Gastroenterol 2011;106(Suppl 2):S417-8).

    Received 4 January 2012; accepted 19 April 2012. published online 25 June 2012.

    Background

    Recent studies using split-dose preparations (SDPs) suggest a significant improvement in the quality of preparation and patient compliance. However, the effects of SDP on other quality indicators of colonoscopy, such as cecal intubation and adenoma detection rates, have not been previously reported, to our knowledge.

    Objective

    The primary objective of this study was to compare polyp detection rates (PDRs) and adenoma detection rates (ADRs) before and after the implementation of an SDP as the preferred bowel preparation. The secondary objectives were to compare the quality of the preparation and colonoscopy completion rates before and after implementation of the SDP.

    Design

    Retrospective study.

    Setting

    Tertiary care medical center.

    Patients

    Patients undergoing colonoscopy for screening and surveillance of colon polyps and cancer.

    Interventions

    System-wide implementation of SDP.

    Results

    A total of 3560 patients in the pre-SDP group and 1615 patients in the post-SDP group were included in the study. SDP use increased significantly from 9% to 74% after implementation. In comparison with the pre-SDP group, both PDRs (44.1%-49.5%; P < .001) and ADRs (26.7%-31.8%; P < .001) significantly improved in the post-SDP group. The colonoscopy completion rate significantly increased from 93.6% to 95.5% in the post-SDP group (P = .008). Bowel preparation quality also improved significantly (P < .001) in the post-SDP group.

    Limitations

    Retrospective design; not all endoscopists were the same in both periods.

    Conclusions

    System-wide implementation of an SDP as the primary choice for colonoscopy significantly improved both PDRs and ADRs, overall quality of the preparation, and colonoscopy completion rates.

    Abbreviations:  ADR, adenoma detection rate, PDR, polyp detection rate, PEG, polyethylene glycol, SDP, split-dose preparation, SSA, sessile serrated adenoma

     

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