Modifiable endoscopic factors that influence the adenoma detection rate in colorectal cancer screening colonoscopies

被引：127

作者：

Jover, Rodrigo ^{[1
]}

Zapater, Pedro ^{[2
]}

Polana, Eduardo ^{[1
]}

Bujanda, Luis ^{[3
]}

Lanas, Angel ^{[4
]}

Hermo, Jose A. ^{[5
]}

Cubiella, Joaquin ^{[6
]}

Ono, Akiko ^{[7
]}

Gonzalez-Mendez, Yanira ^{[8
]}

Peris, Antonio ^{[9
]}

Pellise, Maria ^{[10
]}

Seoane, Agustin ^{[11
]}

Herreros-de-Tejada, Alberto ^{[12
]}

Ponce, Marta ^{[13
]}

Marin-Gabriel, Jose C. ^{[14
]}

Chaparro, Maria ^{[15
]}

Cacho, Guillermo ^{[16
]}

Fernandez-Diez, Servando ^{[17
]}

Arenas, Juan ^{[18
]}

Sopena, Federico ^{[4
]}

de-Castro, Luisa ^{[5
]}

Vega-Villaamil, Pablo ^{[6
]}

Rodriguez-Soler, Maria ^{[1
]}

Carballo, Fernando ^{[7
]}

Salas, Dolores ^{[19
]}

Morillas, Juan D. ^{[17
]}

Andreu, Montserrat ^{[11
]}

Quintero, Enrique ^{[8
]}

Castells, Antoni ^{[10
]}

机构：

[1] Hosp Gen Univ Alicante, Unidad Gastroenterol, Alicante 03010, Spain

[2] Hosp Gen Univ Alicante, Dept Clin Pharmacol, Alicante 03010, Spain

[3] Univ Basque Country, CIBERehd, Hosp Donostia, Dept Gastroenterol, San Sebastian, Spain

[4] Univ Zaragoza, Dept Gastroenterol, Hosp Clin Lozano Blesa, CIBERehd, Zaragoza, Spain

[5] Complexo Hosp Vigo, Dept Gastroenterol, Vigo, Spain

[6] Complexo Hosp Ourense, Dept Gastroenterol, Orense, Spain

[7] Hosp Univ Virgen de la Arrixaca, Unidad Gest Clin Digest, Inst Murciano Invest Biosanitaria, Murcia, Spain

[8] Hosp Univ Canarias, Dept Gastroenterol, Santa Cruz De Tenerife, Spain

[9] Complejo Hosp Castellon, Dept Gastroenterol, Castellon De La Plana, Spain

[10] Univ Barcelona, Dept Gastroenterol, Hosp Clin, CIBERehd,IDIBAPS, Barcelona, Spain

[11] Hosp del Mar, Dept Gastroenterol, Barcelona, Spain

[12] Hosp Puerta de Hierro, Dept Gastroenterol, Madrid, Spain

[13] Hosp Univ La Fe, Dept Gastroenterol, Valencia, Spain

[14] Hosp 12 Octubre, Dept Gastroenterol, E-28041 Madrid, Spain

[15] Hosp de la Princesa, Dept Gastroenterol, CIBERehd, Madrid, Spain

[16] Fdn Hosp Alcorcon, Dept Gastroenterol, Madrid, Spain

[17] Hosp Clin San Carlos, Dept Gastroenterol, Madrid, Spain

[18] Policlin Guipuzkoa, Dept Gastroenterol, San Sebastian, Spain

[19] Conselleria Sanitat, Direcc Gen Salud Publ, Canc Screening Program, Valencia, Spain

来源：

GASTROINTESTINAL ENDOSCOPY | 2013年 / 77卷 / 03期

关键词：

FECAL OCCULT BLOOD; QUALITY INDICATORS; TECHNICAL PERFORMANCE; ASYMPTOMATIC ADULTS; COLONIC NEOPLASIA; BOWEL PREPARATION; WITHDRAWAL TIME; POLYP DETECTION; POLYPECTOMY; PREVENTION;

D O I：

10.1016/j.gie.2012.09.027

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

100201 [内科学];

摘要：

Background: Adenoma detection rate (ADR) has become the most important quality indicator for colonoscopy. Objective: The aim of this study was to investigate which modifiable factors, directly related to the endoscopic procedure, influenced the ADR in screening colonoscopies. Design: Observational, nested study. Setting: Multicenter, randomized, controlled trials. Patients: Asymptomatic people aged 50 to 69 years were eligible for a multicenter, randomized, controlled trial designed to compare colonoscopy and fecal immunochemical testing in colorectal cancer screening. A total of 4539 individuals undergoing a direct screening colonoscopy were included in this study. Intervention: Colonoscopy. Main Outcome Measurements: Bowel cleansing, sedation, withdrawal time in normal colonoscopies, and cecal intubation were analyzed as possible predictors of adenoma detection by using logistic regression analysis, adjusted for age and sex. Results: In multivariate analysis, after adjustment for age and sex, factors independently related to the ADR were a mean withdrawal time longer than 8 minutes (odds ratio [OR] 1.51; 95% CI, 1.17-1.96) in normal colonoscopies and split preparation (OR 1.26; 95% CI, 1.01-1.57). For advanced adenomas, only withdrawal time maintained statistical significance in the multivariate analysis. For proximal adenomas, withdrawal time and cecal intubation maintained independent statistical significance, whereas only withdrawal time longer than 8 minutes and a <10-hour period between the end of preparation and colonoscopy showed independent associations for distal adenomas. Limitations: Only endoscopic variables have been analyzed. Conclusion: Withdrawal time was the only modifiable factor related to the ADR in colorectal cancer screening colonoscopies associated with an increased detection rate of overall, advanced, proximal, and distal adenomas. (Gastrointest Endosc 2013;77:381-9.)

引用

页码：381 / +

页数：10

共 31 条

[1]

Adler A, GUT

[2]

Bowel preparation scale [J].

Aronchick, CA .

GASTROINTESTINAL ENDOSCOPY, 2004, 60 (06) :1037-1038

[3]

Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial [J].

Atkin, Wendy S. ;

Edwards, Rob ;

Kralj-Hans, Ines ;

Wooldrage, Kate ;

Hart, Andrew R. ;

Northover, John M. A. ;

Parkin, D. Max ;

Wardle, Jane ;

Duffy, Stephen W. ;

Cuzick, Jack .

LANCET, 2010, 375 (9726) :1624-1633

[4]

Effect of a Time-Dependent Colonoscopic Withdrawal Protocol on Adenoma Detection During Screening Colonoscopy [J].

Barclay, Robert L. ;

Vicari, Joseph J. ;

Greenlaw, Roger L. .

CLINICAL GASTROENTEROLOGY AND HEPATOLOGY, 2008, 6 (10) :1091-1098

[5]

Colonoscopic withdrawal times and adenoma detection during screening colonoscopy [J].

Barclay, Robert L. ;

Vicari, Joseph J. ;

Doughty, Andrea S. ;

Johanson, John F. ;

Greenlaw, Roger L. .

NEW ENGLAND JOURNAL OF MEDICINE, 2006, 355 (24) :2533-2541

[6]

Variations between endoscopists in rates of detection of colorectal neoplasia and their impact on a regional screening program based on colonoscopy after fecal occult blood testing [J].

Bretagne, Jean-Francois ;

Hamonic, Stephanie ;

Piette, Christine ;

Manfredi, Sylvain ;

Leray, Emmanuelle ;

Durand, Gerard ;

Riou, Francoise .

GASTROINTESTINAL ENDOSCOPY, 2010, 71 (02) :335-341

[7]

Endoscopist can be more powerful than age and male gender in predicting adenoma detection at colonoscopy [J].

Chen, Shawn C. ;

Rex, Douglas K. .

AMERICAN JOURNAL OF GASTROENTEROLOGY, 2007, 102 (04) :856-861

[8]

Impact of colonic cleansing on quality and diagnostic yield of colonoscopy: the European Panel of Appropriateness of Gastrointestinal Endoscopy European multicenter study [J].

Froehlich, F ;

Wietlisbach, V ;

Gonvers, JJ ;

Burnand, B ;

Vader, JP .

GASTROINTESTINAL ENDOSCOPY, 2005, 61 (03) :378-384

[9]

Impact of colonoscopy preparation quality on detection of suspected colonic neoplasia [J].

Harewood, GC ;

Sharma, VK ;

de Garmo, P .

GASTROINTESTINAL ENDOSCOPY, 2003, 58 (01) :76-79

[10]

Risk of advanced proximal neoplasms in asymptomatic adults according to the distal colorectal findings [J].

Imperiale, TF ;

Wagner, DR ;

Lin, CY ;

Larkin, GN ;

Rogge, JD ;

Ransohoff, DF .

NEW ENGLAND JOURNAL OF MEDICINE, 2000, 343 (03) :169-174

← 1 2 3 4 →