结肠镜检查中大肠腺瘤的漏诊率及漏诊相关危险因素

目的 明确结肠镜检查中大肠腺瘤的漏诊率及漏诊腺瘤特征,探讨腺瘤漏诊的相关危险因素.方法 患者在初次结肠镜检查发现并切除腺瘤后120 d内进行结肠镜复查,分析2次结肠镜检查结果.记录2次结肠镜检查所见腺瘤的特征(包括大小、部位、形态、数目及病理)、患者临床特征(包括年龄、性别、结肠镜检查原因、腹部及盆腔手术史、大肠憩室病史及是否行无痛结肠镜检查)及不同的内镜操作医师.分析不同类型腺瘤在结肠镜检查中的漏诊率以及腺瘤特征、患者临床特征和内镜医师的操作水平对腺瘤漏诊的影响.结果 809例患者中271例发生腺瘤漏诊,2次结肠镜检查共检出腺瘤2134颗,漏诊腺瘤425颗,腺瘤总漏诊率为20%(425/2134);平均患者腺瘤漏诊率为33%(271/809).腺瘤体积大者,漏诊率低(P<0.01);乙状结肠、肝曲、盲肠和升结肠部位的腺瘤以及平坦型腺瘤容易漏诊(P<0.05);患者腺瘤数越多在结肠镜检查中腺瘤漏诊率越高(P<0.01);初级内镜医师与有经验内镜医师相比,其漏诊率明显增加(P<0.01).结论 结肠镜检查中存在部分腺瘤漏诊,腺瘤漏诊与腺瘤大小、形态、部位、数目以及结肠镜检查操作医师密切相关.     

结肠镜检查中大肠腺瘤的漏诊率及漏诊相关危险因素

目的 明确结肠镜检查中大肠腺瘤的漏诊率及漏诊腺瘤特征,探讨腺瘤漏诊的相关危险因素.方法 患者在初次结肠镜检查发现并切除腺瘤后120 d内进行结肠镜复查,分析2次结肠镜检查结果.记录2次结肠镜检查所见腺瘤的特征（包括大小、部位、形态、数目及病理）、患者临床特征（包括年龄、性别、结肠镜检查原因、腹部及盆腔手术史、大肠憩室病史及是否行无痛结肠镜检查）及不同的内镜操作医师.分析不同类型腺瘤在结肠镜检查中的漏诊率以及腺瘤特征、患者临床特征和内镜医师的操作水平对腺瘤漏诊的影响.结果 809例患者中271例发生腺瘤漏诊,2次结肠镜检查共检出腺瘤2134颗,漏诊腺瘤425颗,腺瘤总漏诊率为20%（425/2134）;平均患者腺瘤漏诊率为33%（271/809）.腺瘤体积大者,漏诊率低（P〈0.01）;乙状结肠、肝曲、盲肠和升结肠部位的腺瘤以及平坦型腺瘤容易漏诊（P〈0.05）;患者腺瘤数越多在结肠镜检查中腺瘤漏诊率越高（P〈0.01）;初级内镜医师与有经验内镜医师相比,其漏诊率明显增加（P〈0.01）.结论 结肠镜检查中存在部分腺瘤漏诊,腺瘤漏诊与腺瘤大小、形态、部位、数目以及结肠镜检查操作医师密切相关.     

代谢综合征与大肠腺瘤的相关性研究

目的 研究代谢综合征(MS)与大肠腺瘤的相关性.方法 选取2009年6月～2012年6月所有接受结肠镜检查的患者,根据排除标准及肠镜检查结果诊断大肠腺瘤组455例,同时选取同期年龄匹配,肠镜结果未见异常的体检者455例为对照组.所有研究对象均检查空腹血糖、血脂,并测量血压、腰围,记录肠镜下腺瘤分布部位、大小、病理结果.对大肠腺瘤组与对照组各临床参数进行比较,运用Logistic回归分析代谢综合征与大肠腺瘤的相关性.结果 (1)大肠腺瘤组代谢综合征患病率高于对照组(P＜0.01),代谢综合征及血糖异常是大肠腺瘤的独立危险因素;(2)代谢综合征病种数量在个体聚集越多,患大肠腺瘤可能性越大;(3)大肠腺瘤合并代谢综合征患者大肠腺瘤数目多为3个或以上,大小为5 ～9 mm,病理多呈进展性改变.结论 代谢综合征与大肠腺瘤密切相关,尽早对代谢综合征患者行结肠镜检查,有利于大肠腺瘤的防治.     

结直肠平坦型腺瘤肠镜检出的可控影响因素分析

目的探讨结直肠平坦型腺瘤肠镜检出率(flat adenoma detection rate,FADR)的可控影响因素,以提高结肠镜检查质量。方法回顾性分析2 986例患者的临床内镜资料,按肠道清洁度及内镜操作医师的特征(包括操作例数、专业背景、操作方式及退镜时间)计算出FADR,再比较各组FADR的差异,对差异有统计学意义的影响因素进行Logistic回归分析。结果单因素分析显示肠道清洁度、操作例数、操作方式及退镜时间对FADR有显著影响(P0.01),而操作医师的专业背景对FADR的影响无统计学意义(P0.05);多因素分析结果显示肠道清洁度、操作例数、操作方式及退镜时间是FADR的独立影响因素。结论在良好的肠道准备条件下,操作医生累积结肠镜操作1 000例以上,采用单人操作法,保证退镜时间在6 min以上可显著提高FADR,从而有效提高结肠镜检查质量。     

结肠镜筛查质量的相关因素研究进展

近年来,我国的结直肠癌发病率及死亡率呈逐渐上升趋势,而大多数结直肠癌起源于腺瘤。结肠镜检查发现并切除腺瘤是降低结直肠癌风险的重要手段,但存在一定的腺瘤漏诊率,因此,早期进行结肠镜筛查,提高筛查质量,降低腺瘤漏诊,提高腺瘤检出率,对预防结直肠癌具有重要的意义。目前已有多项研究表明,结肠镜筛查质量受多种客观及主观因素影响,包括患者特征、病变性状、肠道准备情况、盲肠插管率、操作时长及结肠镜辅助技术等因素。本文就结肠镜筛查质量的相关因素研究进展作一综述。     

单中心结肠镜质量控制的回顾性横断面研究

目的　全面评价甘肃省人民医院内镜中心结肠镜检查质量,为评估我国目前消化内镜检查质量提供基线数据和理论依据。方法　依托甘肃省人民医院内镜中心数据库,采用单中心、回顾性、横断面研究方法,收集2021年1月1日—2021年12月31日在甘肃省人民医院消化内镜中心行结肠镜检查的全部患者资料,分析息肉检出率、腺瘤检出率、盲肠插管率、肠道准备充分率等质控指标,评价本中心结肠镜检查质量。结果　研究共纳入7 562例结肠镜检查患者,年龄（51.61±13.59）岁,其中男4 286例（56.7%）、女3 276例（43.3%）。门诊患者4 924例（65.1%）,住院患者2 638例（34.9%）。由专职内镜医师完成检查患者6 456例（85.4%）,由非专职医师（消化科或肛肠科医师）完成检查患者1 106例（14.6%）。总体腺瘤检出率、息肉检出率、盲肠插管率、肠道准备充分率分别为11.9%（900/7 562）、32.9%（2 488/7 562）、93.0%（7 030/7 562）、91.3%（6 906/7 562）。男性、高年龄段、住院患者以及由专职内镜医师完成检查患者的腺瘤检出率、息肉检出率更高,差异有统计学意义（P<0.05）。结论　甘肃省人民医院结肠镜检查的盲肠插管率、肠道准备充分率均能达到现有指南要求,但仍需进一步提高腺瘤检出率。高龄、男性是结肠镜筛查的重点人群。此外,应重视对内镜检查医师规范化培训,以进一步提高结肠镜检查质量。     

乙状结肠镜检查对大肠肿瘤的漏诊研究

目的 探讨乙状结肠镜检查对大肠肿瘤的漏诊情况.方法 总结分析惠州市中心人民医院(2006年～2008年)和广州南方医院(2004年～2006年)行结肠镜检查发现大肠肿瘤者、年龄为50～79岁的连续性资料.结果 72.0%近端大肠肿瘤患者在其远端大肠未发现相应肿瘤性病变,其中男性该比例为66.5%,女性为82.3%;50～59岁、60～69岁、70～79岁年龄段的比例分别为74.7%、72.0%、67.9%.远近端大肠高级别癌灶比例分别为5.1%和15.8%(P<0.01).结论 近端大肠癌的恶性程度较远端大肠癌高;如果乙状结肠镜发现远端大肠肿瘤才进行全结肠镜检查,将导致72.0%近端大肠肿瘤漏诊.     

2667例患者结直肠息肉诊治及随访分析

目的观察结直肠息肉在诊治过程中的漏诊、复发、再发情况及其相关因素。方法对2005年3月至2015年3月在江苏省人民医院接受肠镜检查或治疗的患者临床资料进行回顾性分析,记录性别、年龄、息肉大小、数目、部位、形态、治疗方式及医师操作例数、退镜时间、肠道准备情况等临床资料,计算息肉漏诊率、复发率及再发率,分析所得数据与影响因素间的关系。结果可统计的464例患者中共发现息肉1 446枚,息肉漏诊率为23.6%,患者漏诊率为37.1%。直径5 mm、位于右侧结肠、无蒂息肉易漏诊,医师经验不足(500例)、息肉多发、退镜时间不充分(6 min)均为导致漏诊率增加的独立危险因素。2 203例患者中发现复发94例,年龄≥65岁、男性、多发息肉患者、左侧结肠、较大息肉易复发(P0.05),ESD及EMR复发率最低,钳夹最高。5年内再发患者899例,再发率为40.8%,其中35.7%于1年内再发,68.3%于2年内再发。≥65岁、男性、多发息肉患者、全结肠息肉易再发,再发率与息肉大小无关。结论结肠镜检查中需认真细致,减少漏诊,治疗中正确选用不同的内镜手术方式,耐心、仔细地对多发息肉、小息肉、不同部位的息肉等进行检查及治疗,提高肠道准备质量及内镜医师的诊疗水平,保证退镜时间充分,避免息肉残留及降低息肉漏诊率和再发率。     

提高结肠镜腺瘤检出率的技术进展

结直肠癌一直属于世界范围内主要的癌症死因之一，如何提高其癌前病变，即腺瘤检出率，一直是内镜医生的努力方向。结肠镜腺瘤总体漏诊率高达20％～25％，除受内镜医生诊断经验、操作水平、退镜检查时间和患者肠道清洁度影响以外，肠道解剖结构、结肠镜的肠腔盲区均是病变漏诊的重要原因。本文即综述了近年来，对上述问题进行的内镜器械及技术方面的改进。     

单中心结肠镜质量控制的回顾性横断面研究

目的全面评价甘肃省人民医院内镜中心结肠镜检查质量, 为评估我国目前消化内镜检查质量提供基线数据和理论依据。方法依托甘肃省人民医院内镜中心数据库, 采用单中心、回顾性、横断面研究方法, 收集2021年1月1日—2021年12月31日在甘肃省人民医院消化内镜中心行结肠镜检查的全部患者资料, 分析息肉检出率、腺瘤检出率、盲肠插管率、肠道准备充分率等质控指标, 评价本中心结肠镜检查质量。结果研究共纳入7 562例结肠镜检查患者, 年龄(51.61±13.59)岁, 其中男4 286例(56.7%)、女3 276例(43.3%)。门诊患者4 924例(65.1%), 住院患者2 638例(34.9%)。由专职内镜医师完成检查患者6 456例(85.4%), 由非专职医师(消化科或肛肠科医师)完成检查患者1 106例(14.6%)。总体腺瘤检出率、息肉检出率、盲肠插管率、肠道准备充分率分别为11.9%(900/7 562)、32.9%(2 488/7 562)、93.0%(7 030/7 562)、91.3%(6 906/7 562)。男性、高年龄段、住院患者以及由专职内镜医师完成检查患者的腺瘤检...     

The Miss Rate for Colorectal Adenoma Determined by Quality-Adjusted, Back-to-Back Colonoscopies

Background/Aims

Colonoscopy is considered to be the gold standard for detecting adenomatous polyps. Polyps are missed during colonoscopic examination at a rate that varies from 6% to 27%. The adenoma miss rate affects colonoscopic surveillance intervals and procedural quality. We aimed to assess the adenoma miss rate and the variables affecting the rate using same-day, quality-adjusted, back-to-back colonoscopies.

Methods

This prospective study was performed at a single institution and included 149 patients. Two consecutive same-day colonoscopies were performed by two experienced endoscopists. The adenoma miss rates and variables affecting the missed adenomas, including polyp characteristics and procedure times, were evaluated.

Results

The miss rates of polyps, adenomas, and advanced adenomas were 16.8%, 17%, and 5.4%, respectively. The smaller polyps and increased number of polyps detected during the first colonoscopy were more likely to be missed. A longer insertion time during the colonoscopy was correlated with an increased adenoma detection rate.

Conclusions

There was a significant miss rate in the detection of colonic adenomas even in quality-adjusted, back-to-back colonoscopies. The adenoma miss rate can be reduced with a sufficient observation time during colonoscopic insertion. The development of specific technological methods to reduce the adenoma miss rate is necessary.     

Correlation between Surrogate Quality Indicators for Adenoma Detection Rate and Adenoma Miss Rate in Qualified Colonoscopy,CORE Study: KASID Multicenter Study

Background/AimsThe adenoma detection rate (ADR) does not reflect the complete detection of every adenoma during colonoscopy; thus, many surrogate indicators have been suggested. This study investigated whether the ADR and surrogate quality indicators reflect the adenoma miss rate (AMR) when performing qualified colonoscopy.MethodsWe performed a prospective, multicenter, cross-sectional study of asymptomatic examinees aged 50 to 75 years who underwent back-to-back screening colonoscopies by eight endoscopists. The ADR and surrogate quality indicators, including polyp detection rate, total number of adenomas per colonoscopy, additional adenomas found after the first adenoma per colonoscopy (ADR-Plus), and total number of adenomas per positive participant, were calculated for the prediction of AMR.ResultsA total of 371 back-to-back colonoscopies were performed. There was a significant difference in ADRs (range, 44% to 75.4%; p=0.024), polyp detection rates (range, 56% to 86.9%; p=0.008) and adenomas per positive participants (range, 1.19 to 2.30; p=0.038), and a tendency of a difference in adenomas per colonoscopy (range, 0.62 to 1.31; p=0.051) and ADR-Plus (range, 0.13 to 0.70; p=0.054) among the endoscopists. The overall AMR was 20.1%, and AMRs were not different (range, 13.9 to 28.6; p>0.05) among the endoscopists. No quality indicators were significantly correlated with AMR. The number of adenomas found during the first colonoscopy was an independent factor for increased AMR (odds ratio, 1.79; p<0.001).ConclusionsThe colonoscopy quality indicators were significantly different among high-ADR endoscopists, and none of the quality indicators reflected the AMR of good quality colonoscopy performances. The only factor influencing AMR was the number of adenomas detected during colonoscopy.     

Effect of water exchange method on adenoma miss rate of patients undergoing selective polypectomy: A randomized controlled trial

BackgroundAdenomas may be missed in up to 40% of screening colonoscopies. Although the water exchange (WE) method can improve ADR, as shown in several RCTs, it remains uncertain whether it can increase the detection of missing adenomas compared with standard air-insufflated (AI) colonoscopy.MethodsPatients aged 18–80 years who underwent selective polypectomy were randomly allocated to the WE or AI group. The primary endpoint was the adenoma miss rate (AMR), defined as the number of patients with one or more additional adenomas during the polypectomy procedure divided by the total number of patients in each group.ResultsA total of 450 patients were enrolled, with 225 in each group. The overall AMRs were 45.8% (103/225) in the WE group and 35.6% (80/225) in the AI group (p = 0.035). More patients in the WE group had at least one missed adenoma in the proximal colon (38.2% vs 24.4%, p = 0.002). The adenoma-level miss rate was also higher in the WE group than in the AI group (35.1% vs 29.0%, p = 0.036). Subgroup analysis showed that patients in the WE group had more missed adenomas located in the proximal colon or with flat shapes.ConclusionsThis study confirmed that substantial adenomas were missed in patients undergoing selective polypectomy. The WE method significantly improved the detection of missed adenomas, especially those located in the proximal colon or with flat shapes. (ClnicalTrials.gov number: NCT02880748)     

Findings on optical colonoscopy after positive CT colonography exam

BACKGROUND & AIMS:  The aim of this study is to evaluate the findings on optical colonoscopy (OC) after a positive CT colonography (CTC) exam and characterize the type of polyps seen on OC but not reported by CTC.
METHODS:  Over an 18-month period a total of 159 asymptomatic adults had polyps seen on computed tomography colonography examination and subsequently underwent planned therapeutic optical colonoscopy. The colonoscopists were aware of the findings on CT colonography prior to further evaluation of the colon. Characteristics of polyps and adenomas seen on subsequent optical colonoscopy but not seen or reported on CT colonography were examined.
RESULTS:  The adenoma miss rate for CT colonography overall was 18.9% (25/132) including 6.2% (4/65) for polyps >9 mm and 18.2% (8/44) for polyps 6–9 mm. Three of the adenomas >9 mm not seen on CTC were sessile, and two were found in patients with technically difficult CT colonography studies due to poor colonic distention. No adenomas with advanced pathology <6 mm were found on optical colonoscopy but not reported on CT colonography. False-positive CTC referral where no polyp was seen on colonoscopy was 5.0%.
CONCLUSIONS:  CT colonography has adenoma miss rates similar to miss rates historically found with optical colonoscopy, with most missed adenomas being <10 mm and sessile in shape.     

Missed colonic adenomas in routine primary care endoscopy: a prospective tandem colonoscopy study

Colonoscopy is the gold standard in the diagnosis of colorectal neoplasia. Several lines of independent evidence, however, suggest that a significant number of small adenomas and also some advanced lesions are missed even by experienced endoscopists. With large-scale screening colonoscopy programmes installed, information on quality of colonoscopy in primary care is essential, but not available. Between July 2006 and December 2008, a total of 40 patients (23 men and 17 women, median age: 69 years) underwent a second colonoscopy within 42 days after the first endoscopy (median: 11 days), in all cases exclusively for clinical reasons. Index colonoscopy was performed by 14 endoscopists in 6 hospitals and 4 private practices. Data on all consecutive patients were collected prospectively. A total of 98 neoplastic lesions were identified in 34 patients at the index colonoscopy, an additional 53 adenomas were removed at the second colonoscopy, 33 of them smaller than 5 mm. 25 out of 53 missed adenomas were identified between the coecum and the right colonic flexure. 12 of the additional lesions were considered significant lesions (larger than 10 mm or tubulovillous adenoma), nine of these were located between the coecum and the right colonic flexure. In 24 patients repeat colonoscopy detected adenomas not described in the original report. In eight patients a total of 12 significant lesions were removed, nine of these were located between the coecum and the right colonic flexure. About one-third of adenomas were missed in 40 routine colonoscopies, most of them only small and therefore probably of little clinical significance. However, 12 significant lesions were missed in 8 patients. Adenomas in the right colon seem to be a particular problem.     

Acceptability, effectiveness, and cost-effectiveness of internet-based exposure treatment for irritable bowel syndrome in a clinical sample: a randomized controlled trial

Background

A colonoscopy may frequently miss polyps and cancers. A number of techniques have emerged to improve visualization and to reduce the rate of adenoma miss.

Methods

We conducted a randomized controlled trial (RCT) in two clinics of the Gastrointestinal Department of the Sanitas University Foundation in Bogota, Colombia. Eligible adult patients presenting for screening or diagnostic elective colonoscopy were randomlsy allocated to undergo conventional colonoscopy or narrow-band imaging (NBI) during instrument withdrawal by three experienced endoscopists. For the systematic review, studies were identified from the Cochrane Library, PUBMED and LILACS and assessed using the Cochrane risk of bias tool.

Results

We enrolled a total of 482 patients (62.5% female), with a mean age of 58.33 years (SD 12.91); 241 into the intervention (NBI) colonoscopy and 241 into the conventional colonoscopy group. Most patients presented for diagnostic colonoscopy (75.3%). The overall rate of polyp detection was significantly higher in the conventional group compared to the NBI group (RR 0.75, 95%CI 0.60 to 0.96). However, no significant differences were found in the mean number of polyps (MD -0.1; 95%CI -0.25 to 0.05), and the mean number of adenomas (MD 0.04 95%CI -0.09 to 0.17). Meta-analysis of studies (regardless of indication) did not find any significant differences in the mean number of polyps (5 RCT, 2479 participants; WMD -0.07 95% CI -0.21 to 0.07; I2 68%), the mean number of adenomas (8 RCT, 3517 participants; WMD -0.08 95% CI -0.17; 0.01 to I2 62%) and the rate of patients with at least one adenoma (8 RCT, 3512 participants, RR 0.96 95% CI 0.88 to 1,04;I2 0%).

Conclusion

NBI does not improve detection of colorectal polyps when compared to conventional colonoscopy (Australian New Zealand Clinical Trials Registry ACTRN12610000456055).     

Retrospective analysis of missed advanced adenomas on surveillance colonoscopy

OBJECTIVE: Miss rates of large polyp/cancer during colonoscopy are reported from tertiary centers where experts do the colonoscopies. This information is important for determining surveillance intervals for repeat colonoscopy, patient safety, and malpractice issues. We evaluated retrospectively the miss rates of advanced adenomas in the setting of a GI fellowship training where most colonoscopies are done by closely supervised fellows. METHODS: We reviewed the 235 patients who had at least one repeat colonoscopy after initial polypectomy, between 1992 and 1999, at the Dayton Veterans Affairs Medical Center. Advanced adenomas were defined as polyps 10 mm or greater in size with or without a villous component or high-grade dysplasia. Data of missed advanced adenomas on 122 patients who had complete colonoscopy with satisfactory preparation and the excluded patients are reported. RESULTS: Four advanced adenomas (one had intramucosal cancer) on second colonoscopy and two advanced adenomas on third colonoscopy were missed. The miss rate of advanced adenoma for 232 patients was 1.7%, and the miss rate for the 122 patients with complete colonoscopy and satisfactory colon preparation was 2.5% and 3.3% on second and third repeat colonoscopy, respectively. No cancer was missed. CONCLUSIONS: The present study shows an advanced polyp miss rate that is comparable with other studies even in a fellowship training setting. Prospective studies with tandem surveillance colonoscopy are needed to confirm our findings.     

An Italian prospective multicenter study on colonoscopy practice and quality: What has changed in the last 10 years

BackgroundA relevant number of adenomas can be missed during colonoscopy.AimsAssess the current status of colonoscopy procedures in Italian centers.MethodsA prospective observational study involving 17 hospitals (34 endoscopists) included consecutive patients undergoing standard colonoscopy. In the first phase, endoscopists performed consecutive colonoscopies. In the second phase, retraining via an online learning platform was planned, while in the third phase data were collected analogously to phase 1.ResultsA total of 3,504 patients were enrolled. Overall, a BBPS score ≥6 was obtained in 95.6% of cases (94.8% and 96.9% in the pre- and post-training phases, respectively). 88.4% of colonoscopies had a withdrawal time ≥6 min (88.2% and 88.7% in the pre- and post-training phases). Median adenoma detection rate (ADR) was 39.1%, with no significant differences between the pre- and post-training phases (40.1% vs 36.9%; P = 0.83). In total, 81% of endoscopists had a ADR performance above the 25% threshold.ConclusionHigh colonoscopy quality standards are achieved by the Italian hospitals involved. Quality improvement initiatives and repeated module-based colonoscopy-training have been promoted in Italy during the last decade, which appear to have had a significant impact on quality colonoscopy metrics together with the activation of colorectal cancer screening programs.