结肠镜学习时间与结肠息肉检出率关系的临床研究
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摘要
目的探讨结肠镜息肉检出率是否随着结肠镜的学习时间的增加而不断提高。方法回顾性分析2016年7月至2018年12月经福建漳州正兴医院4名有经验的肠镜医师A、B、C、D及2名肠镜初学者E、F每半年的结肠镜息肉检出率变化趋势,并进行分析和比较。结果 A、B、C、D、E、F医生总的息肉检出率分别为43.8%(1 107/2 529)、31.8%(420/1 322)、35.3%(619/1 753)、25.2%(194/771)、42.8%(166/388)和29.3%(129/440)。6名肠镜医师之间、4名有经验肠镜医师之间及2名肠镜初学者之间的息肉检出率差异均具有统计学显著性差异。肠镜初学者E医生一年半时间,每半年息肉检出率分别为48.39%(15/31)、42.86%(42/98)和42.08%(109/259),而F医生仅为21.84%(19/87)、32.73%(36/110)和30.45%(74/243),检出率无明显统计学差异。结论结肠镜息肉检出率并不随着结肠镜的学习时间的增加而提高。
Objective To explore whether the detection rate of colonoscopic polyps increases with the increase of learning time of colonoscopy. Methods The detection rates of colorectal polyps in four experienced endoscopists A,B,C,D and two colonoscopy trainees E and F,from July 2016 to December 2018,were analyzed and compared retrospectively.Results The detection rates of polyps in doctors A,B,C, D,E and F were 43.8%(1107/2529),31.8%(420/1322),35.3%(619/1753),25.2%(194/771),42.8%(166/388) and 29.3%(129/440),respectively.There were significant differences in the detection rates of polyps among 6 endoscopists,4 experienced endoscopists and 2 colonoscopy trainees(all the P values were 0.000).The detection rates of polyps in colonoscopy trainees E were 48.39%(15/31),42.86%(42/98) and 42.08%(109/259) every half year,and the data of colonoscopy trainees E were 21.84%(19/87),32.73%(36/110) and 30.45%(74/243) respectively,which were no differences in the detection rates of polyps.Conclusion The detection rate of colonoscopic polyps does not increase with the learning time of colonoscopy.
Objective To explore whether the detection rate of colonoscopic polyps increases with the increase of learning time of colonoscopy. Methods The detection rates of colorectal polyps in four experienced endoscopists A,B,C,D and two colonoscopy trainees E and F,from July 2016 to December 2018,were analyzed and compared retrospectively.Results The detection rates of polyps in doctors A,B,C, D,E and F were 43.8%(1107/2529),31.8%(420/1322),35.3%(619/1753),25.2%(194/771),42.8%(166/388) and 29.3%(129/440),respectively.There were significant differences in the detection rates of polyps among 6 endoscopists,4 experienced endoscopists and 2 colonoscopy trainees(all the P values were 0.000).The detection rates of polyps in colonoscopy trainees E were 48.39%(15/31),42.86%(42/98) and 42.08%(109/259) every half year,and the data of colonoscopy trainees E were 21.84%(19/87),32.73%(36/110) and 30.45%(74/243) respectively,which were no differences in the detection rates of polyps.Conclusion The detection rate of colonoscopic polyps does not increase with the learning time of colonoscopy.
引文
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[14] 张帅,张鸣青,苏军凯,等.透明帽在单人肠镜检查中的临床应用价值[J/CD].中华胃肠内镜电子杂志,2015,2(2):21- 24.
[15] Desai M,Sanchez- Yague A,Choudhary A,et al.Impact of cap- assisted colonoscopy on detection of proximal colon adenomas:systematic review and met A-analysis[J].Gastrointest Endosc,2017,86(2):274- 281.
[2] Mahadev S,Jin Z,Lebwohl B,et al.Trainee colonoscopy quality is influenced by the independent and unobserved performance characteristics of supervising physicians[J].Endosc Int Open,2019,7(1):E74- E82.
[3] Rex DK,Schoenfeld PS,Cohen J,et al.Quality indicators for colonoscopy[J].Am J Gastroenterol,2015,110(1):72- 90.
[4] Ward ST,Mohammed MA,Walt R,et al.An analysis of the learning curve to achieve competency at colonoscopy using the JETS database[J].Gut,2014,63(11):1746- 1754.
[5] Fernández- Landa MJ,Aginagalde AH,Aran A-Arri E,et al.Quality indicators and patient satisfaction in colonoscopy[J].Gastroenterol Hepatol,2019,42(2):73- 81.
[6] Shaukat A,Gravely AA,Kim AS,et al.Rates of Detection of Adenoma,Sessile Serrated Adenoma,and Advanced Adenoma Are Stable Over Time and Modifiable[J].Gastroenterology,2019,156(3):816- 817.
[7] Bitar H,Zia H,Bashir M,et al.Impact of fellowship training level on colonoscopy quality and efficiency metrics[J].Gastrointest Endosc,2018,88(2):378- 387.
[8] Spier BJ,Benson M,Pfau PR,et al.Colonoscopy training in gastroenterology fellowships:determining competence[J].Gastrointest Endosc,2010,71(2):319- 324.
[9] Williams JE,Holub JL,Faigel DO.Polypectomy rate is a valid quality measure for colonoscopy:results from a national endoscopy database[J].Gastrointest Endosc,2012,75(3):576- 582.
[10] Francis DL,Rodriguez- Correaet,Daniel T,et al.Application of a conversion factor to estimate the adenoma detection rate from the polyp detection rate[J].Gastrointest Endosc,2011,73(3):493- 497.
[11] Gohel TD,Burke CA,Lankaala P,et al.Polypectomy rate:a surrogate for adenoma detection rate varies by colon segment,gender,and endoscopist[J].Clin Gastroenterol Hepatol,2014,12(7):1137- 1142.
[12] Williams JE,Le TD,Faigel DO.Polypectomy rate as a quality measure for colonoscopy[J].Gastrointest Endosc,2011,73(3):498- 506
[13] 令狐恩强,刘杰,李惠凯,等.透明帽在无痛单人肠镜操作中的作用[J/CD].中华腔镜外科杂志:电子版,2011,4(5):365- 368.
[14] 张帅,张鸣青,苏军凯,等.透明帽在单人肠镜检查中的临床应用价值[J/CD].中华胃肠内镜电子杂志,2015,2(2):21- 24.
[15] Desai M,Sanchez- Yague A,Choudhary A,et al.Impact of cap- assisted colonoscopy on detection of proximal colon adenomas:systematic review and met A-analysis[J].Gastrointest Endosc,2017,86(2):274- 281.