电子胃镜误漏诊的相关因素分析

目的分析近5年山东地区普通电子胃镜检查资料及国内文献报告的胃镜检查中的误漏诊病例，寻找电子胃镜检查中误漏诊的相关因素及规律，探索减少误漏诊的方法。方法检索门诊和住院患者的内镜检查资料，获取漏误诊病例；检索国内文献报导的内镜检查误漏诊病例，进行对比分析。结果漏误诊部位包括：胃底-贲门部、胃窦、十二指肠降段、其他，Crude OR值分别为1、1．02、0．81、0．95、1．20，P〈0．05；环境因素包括胃肠准备不理想、无辅助人员、医院级别低、设备配置差，Crude OR值分别为1、1．69、0．95、1．10，P〈0．05；对疾病尤其是少见病的认识程度包括认识、认识差、不认识，未想到，Crude OR值分别为1、1．94、1．23，P〈0．05；检查因素包括存在操作盲区、技术生疏，未行旋转、检查不全面、活检不规范、未行活检、病理不明确，Crude OR值分别为1、2．39、0．76、1．69、1．25、4．31，P〈0．05；患者因素包括认知水平低、操作不配合，Crude OR值分别为1、1．19，P〉0．05。结论电子内镜误漏诊相关因素：包括疾病类型及病变部位、内镜检查环境和医生技术水平等。可以通过改进相关因素来减少误漏诊，同时结合其他检查手段，如超声内镜、色素内镜、放大内镜等新型胃肠镜技术，以及上消化道钡餐造影、腹部CT等来提高诊断率。

Analysis of misdiagnosis and missed diagnosis after gastrointestinal endoscope and related risk factors: a population-based analysis

Objective To evaluate the frequency and risk factors for the missed diagnosis and misdiagnosis rate in the examination of gastrointestinal endoscopes and to explore the methods to decrease it in our district. Methods The relevant data were collected from the inpatients and outpatients who underwent colonoscopy or gastro-scope over the past 5years. Related Chinese literatures published were retrieved. A Comparative Analysis was con-ducted. Results Independent risk factors for the location of lesions were gastric fundus and cardiac part, the upper esophagus, gastric antrum, descending part of duodenum older age(Crude OR:1, 1.02, 0.81,0.95, P<0.05). Some environment factors, such as the inadequacy of gastrointestinal endoscopy preparation, the lack of assistants, the low grade of hospital, the poor medical equipment (Crude OR:1, 1.69, 0.95, 1.10, P<0.05), which impact the missed diagnosis and misdiagnosis rats. The level of recognition of some uncommon and atypical diseases were divided into three grade: good, fit and poor (Crude OR:1, 1.94, 1.23, P<0.05). Clinical factors relating to the success of the procedure were including: more blind area, incomplete examination, the endoscopist nonstandard biopsy, without biopsy underwent, indeterminacy of pathological and histochemical changes (Crude OR:1, 2.39, 0.76, 1.69, 1.25, 4.31, P<0.05). In addition, the patient characteristic strongly associated with a new or missed lesions were cognition of disease progression and cooperating with doctors (Crude 1, 1.19, P>0.05). Conclusions The missed diagnosis and misdiagnosis rates of gastrointestinal diseases were associated with the following factors: baseline characteristics of subjects, lesion sites, the experience of the physicians, the adequacy of bowel preparation, and the gastroenterological endoscope setting etc. several technical innovations such as endoscop-ic ultrasonography (EUS), chromoscopy, magnifying endoscopy, upper gastrointestinal Barium opacification and abdominal CT could be used to reduce missing and to increase diagnosis rate.