科研之友
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摘要
Background and study aims: Low adenoma detection rates (ADRs) at colonoscopy are linked to significantly higher interval cancer rates, and vary between colonoscopists. Studies demonstrate that lesion detection is improved by: withdrawal time of >= 6 minutes; use of hyoscine butylbromide; position change; and rectal retroflexion. We evaluated the feasibility of implementing the above "bundle" of interventions into colonoscopy practice, and the effect on ADR. Materials and methods: A longitudinal cohort design was used. Implementation combined central training, local promotion, and feedback. The uptake marker was change in hyoscine butylbromide use. Comparisons were between the 3 months before and the 9 months after the implementation phase, globally, by endoscopy unit and by quartile when colonoscopists were ranked according to baseline ADR. Chi-squared or Fisher's tests were used to evaluate significance. Results: 12 units participated. Global and quartile analyses included data from 118 and 68 colonoscopists and 17508 and 14193 procedures respectively. A significant increase in hyoscine butylbromide use was observed globally (54.4% vs. 15.8 %, P<0.001), in all endoscopy units (P<0.001) and quartiles (P<0.001). A significant increase in ADR was observed globally (18.1% vs. 16.0 %, P=0.002) and in the lower two colonoscopist quartiles (P<0.001), with a nonsignificant increase in the upper middle quartile and a significant fall to 21.5 %. in the upper quartile. The significant variations in ADR among the upper three quartiles disappeared. Conclusion: In routine clinical practice, introduction of a simple, inexpensive, evidence-based "bundle" of measures is feasible and is associated with higher global ADR, driven by improvements amongst the poorest performing colonoscopists.
- 出版日期2015-3
