定期反馈对结直肠癌机会性筛查中 腺瘤检出率的影响
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1.北京市,首都医科大学附属北京世纪坛医院消化内科;2.北京市,北京大学第九临床医学院消化内科;3.北京市,首都医科大学附属北京友谊医院

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北京市科技计划(Z161100000116084);首都卫生发展科研专项 (2020-4-2085)


Effects of regular feedback on the detection rate of adenomas in opportunistic screening of colorectal cancer
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Affiliation:

Beijing shijitan hospital

Fund Project:

Beijing Science and Technology Plan (Z161100000116084); Capital Fund for Health Improvement and Research (2020-4-2085)

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    摘要:

    目的探索在全结肠镜检查行结直肠癌机会性筛查中实行腺瘤检出率(adenoma detection rate,ADR)定期反馈制度是否可提高内镜医师ADR。方法本研究为观察性研究,研究分为3个阶段:干预前的基线阶段(简称干预前)、定期反馈阶段(简称干预期)和干预后阶段(简称干预后)。干预前:回顾2017年6月—2018年5月在首都医科大学附属北京世纪坛医院消化内科进行结直肠癌机会性筛查的所有患者资料,计算每名内镜医师的ADR。干预期:2018年6月—2018年11月由参与反馈的内镜医师对结直肠癌机会性筛查的患者进行全结肠镜检查,每个月初计算每名内镜医师前一个月的ADR并以报告单的形式提供反馈。干预后:2018年12月—2019年1月由参与反馈的内镜医师对结直肠癌机会性筛查的患者进行全结肠镜检查,计算反馈干预停止后每名内镜医师的ADR。比较3个阶段的ADR和息肉检出率(polyp detection rate,PDR)。结果干预前、干预期和干预后分别纳入1 768例、1 308例和344例结直肠癌机会性筛查患者。共有8名内镜医师参与研究全过程。总ADR从干预前的23.70%(419/1 768)升高至干预期的33.72%(441/1 308)(χ2=37.449,P<0.05)。干预后2个月,ADR轻度下降至33.14%(114/344),但与干预前相比,仍然升高(χ2=13.602,P<0.05)。总PDR从干预前的47.17%(834/1 768)提高至干预期的52.68%(689/1 308),两者相比差异有统计学意义(χ2=9.111,P<0.05)。停止干预后,PDR轻度上升至53.78%(185/344),与干预前相比差异有统计学意义(χ2=5.035,P<0.05)。结论在结直肠癌机会性筛查中,对内镜医师进行ADR的定期反馈可以提高结直肠ADR。

    Abstract:

    ObjectiveTo explore whether the regular feedback system in opportunistic screening of colorectal cancer can improve the adenoma detection rate (ADR) of endoscopists. MethodsThis study was an observational study, divided into three stages: the baseline stage before intervention (the pre-intervention period), the regular feedback stage (the intervention period) and the post-intervention stage (the post-intervention period). In the pre-intervention period, all patients who underwent opportunistic screening of colorectal cancer in Department of Gastroenterology in Beijing Shijitan Hospital Affiliated to Capital Medical University from June 2017 to May 2018 were reviewed, and the ADR of each endoscopist was calculated. In the intervention period from June 2018 to November 2018, colonoscopies were performed on patients for opportunistic screening of colorectal cancer by endoscopists who participated in the feedback. The ADR of each endoscopist during the previous month was calculated at the beginning of each month and feedback was provided in the form of a report. In the post-intervention period from December 2018 to January 2019, colonoscopies were performed on patients for opportunistic screening of colorectal cancer by endoscopists who participated in the feedback. The ADR of each endoscopist was calculated after the feedback stopped. ADR and polyp detection rate (PDR) of three stages were compared. ResultsA total of 1 768, 1 308 and 344 patients were enrolled for opportunistic screening of colorectal cancer during the pre-intervention, the intervention and the post-intervention period respectively. Eight endoscopists participated in the whole process of this study. The total ADR increased from 23.70% (419/1 768) in the pre-intervention period to 33.72% (441/1 308) in the intervention period (χ2=37.449, P<0.05). Two months after intervention, ADR decreased slightly to 33.14% (114/344), but was still higher compared with before (χ2=13.602, P<0.05). The total PDR increased from 47.17% (834/1 768) in the pre-intervention period to 52.68% (689/1 308) in the intervention period (χ2=9.111,P<0.05).Two months after the intervention, PDR increased slightly to 53.78% (185/344), and still higher compared with before (χ2=5.035, P<0.05). ConclusionRegular feedback to endoscopists can improve ADR in opportunistic screening of colorectal cancer.

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王亚丹,孙春萍,刘揆亮,等.定期反馈对结直肠癌机会性筛查中 腺瘤检出率的影响[J].中华消化内镜杂志,2021,38(11):876-881.

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  • 收稿日期:2020-09-08
  • 最后修改日期:2021-10-28
  • 录用日期:2020-10-28
  • 在线发布日期: 2021-11-29
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