| Section1 Colonoscopic Lesion Detection Rate in Relatively Asymptomatic Population of Colorectal Cancer and Its Relevant Factors: Retrospective Analysis of Data from a Single Tertiary Medical CenterObjective: ADR is the core index of quality control of colonoscopy,but it is not easy to obtain in clinical practice,and PDR can replace it to some extent,while ARP is internationally Common standard screening populations are not readily available in clinical practice,but we can use RAP with similar definitions but different scope of application to replace it.Therefore,study on PDR in RAP for colonoscopy Quality control has important clinical application value,and research in related fields in China is scarce.The purpose of this study was to investigate lesion detection rate(PDR and CDR)and their age distribution in the RAP of colonoscopy in China,and to analyze the factors affecting lesion detection rate.Methods:Retrospective analysis was applied.The data of the patients who accepted colonoscopy in the Colonoscopic Unit of Shanghai Changhai Hospital in 2015 was collected,from which RAP was picked according to criteria for inclusion and exclusion such age and reason for examination.PDR and CDR were calculated by different genders,age groups and bowel preparation quality.The χ~2 test was used to compare the rates between different groups.Results:A total of 17,205 patients in RAP received complete colonoscopies.The total PDR was 30.58%,males were 36.17%,and females were 24.08%,The difference in PDR between the sexes was statistically significant(P<0.001).PDR increased significantly with age,and the difference was statistically significant(P<0.001).PDR of males in all age groups were significantly higher than that of females,and the differences were statistically significant(P<0.001).PDR of good bowel preparation group was significantly better than that of the poor group,and the difference was statistically significant(32.74% vs 26.00%,P<0.001).The total CDR was 2.62%,2.80% in men and 2.41% in women.There was no significant difference between the sexes in CDR(P=0.115).CDR increased significantly with age,and the difference was statistically significant(P<0.001).CDR in men aged 50-59 and 60-69 were significantly higher than that in women,and the differences were statistically significant(P=0.020 and 0.013),while the differences in other age groups were not statistically significant(-39 years old: P=0.971,40-49 years old: P=0.639,70-years old: P=0.691).CDR of good bowel preparation group was significantly better than that of the poor group,the difference was statistically significant(3.26% vs 1.27%,P<0.001).Conclusion: 1.Lesion detection rate increase with age.Men have a greater risk of polyp than women.The quality of bowel preparation has a direct impact on lesion detection rate.2.We first proposed the concept of RAP,which has a similar definition to the ARP but has a different scope of application.The latter concept is often misused in domestic reports,so the concept of focusing on RAP has its important clinical application value.Section2 Retrospective study of Lesion Miss Rate in colonoscopy from a Single Tertiary Medical CenterObjective: Although ADR is important in the quality control of colonoscopy,its quality control is not comprehensive.AMR has been proved to be a good complement for ADR.Therefore,the study on AMR has important clinical application value for colonoscopy quality control,but so far the data of miss rate has been reported very little,and China lacks relevant data.Our aim is to use retrospective data to provide reference values of AMR for domestic colonoscopy screening,and to judge comparability between AMR from prospective and retrospective data.Methods: Data was retrospectively collected and analyzed from patients who underwent repeated colonoscopy twice or more in the Colonoscopic Unit of Shanghai Changhai Hospital from January to September 2016.Information was recorded including size,location,and pathological type,bowel preparation quality of the first colonoscopy and whether missed within the first colonoscopy of each single adenoma.Missed ratio was compared in different sizes,different parts,different pathological types and different bowel preparation quality.AMR was compared by different risk factors through x2 test and multivariable logistic regression.Results: Around 267 adenomas were detected during 309 pairs of repeated colonoscopies,of which 66 were missed during the first colonoscopies.In univariate analysis,AMR of the lesions small in size(1-5mm),nonadvanced in histology,in poor bowel preparation context and located in the proximal colon,were significantly higher than the opposite ones,and old age(≥60)and male were related to adenoma missing,the differences were all statistically significant(P<0.001,P<0.001,P=0.028,P=0.028,P=0.006,P=0.014).In multivariable logistic regression analysis,adenoma-related factors(diminutive in size,poor bowel preparation and located in ascending colon,transverse colon or sigmoid colon),and patient-related factors(older than 60 years,male and poor bowel preparation)were found to be independently associated with adenoma missing,the differences were all statistically significant(P=0.045,P=0.001,P<0.001,P<0.032,P=0.003,P=0.027,P=0.046,P=0.022).Conclusion: 1.We first report our overall AMR of 24.7% and the retrospective data is comparable to that of tandem studies.2.Several risk factors such as Older age(≥60),male,diminutive in size(1-5mm),nonadvanced in histology,poor bowel preparation,and located in the proximal colon can significantly increase AMR,which should be paid attention to.Section3 Effect of Cecal Retroflexion Observed on Lesion Missing of Proximal Colon in Colonoscopy: Randomized Controlled Clinical Trial(Pre-Test)from a Single Tertiary Medical CenterObjective: How to reduce missed lesion is a major problem in the quality control research of colonoscopy.Colonoscopy retroflexion examination technology has been proved to be effective in solving this problem as a disease-assisted examination technique widely used in clinical practice.However,there is still a lack of comprehensive and in-depth research on the proximal colon with more missed examinations,especially the lack of prospective clinical research evidence.At the same time,most of previous studies have independently used ADR to evaluate adenoma missing which is not comprehensive.The purpose of this study was to use AMR as the main observation index,and to conduct a RCT(pre-test)to initially explore whether cecal reversal observation in colonoscopy could reduce missed lesion of proximal colon.Methods: A single-center,prospective,RCT(pre-test)was used.From February to June 2018,subjects who underwent colonoscopy at the Colonoscopic Unit of Shanghai Changhai Hospital included in the study were randomly assigned to a test group with cecal retroflexion observed or control group.The test group refers to the one who was performed the cecal to the hepatic flexure in first forward examination after cecal intubation,and then reinserted into the cecum and retroflexed to observe in the cecum,and then inspected in second forward examination from the cecum to the hepatic flexure.The control group refers to two forward examinations from the cecum to the hepatic flexure after cecal intubation.All the identified polyps were removed simultaneously in both groups from the cecum to the hepatic flexure.There were no special requirements for other assistive techniques in addition to restrictions on whether or not to perform cecal retroflexion.The two groups were observed and compared by the length of cecal intubation,the length of the cecum and ascending colon,IT,WT,bowel preparation quality,NRS,polyp detected and missed,adenoma detected and missed,etc..The comparison of the count data between the groups was performed by the χ~2 test or the Fisher exact probability method,and the measurement data was compared using the t test.Results: A total of 60 subjects were enrolled in the study,of which 55 completed the study and were included in the analysis(26 in the control group and 29 in the test group).The characteristics of the subjects included age,gender,indications,type of laxatives,and time period of examination.There were no significant differences statistically between the two groups(P=0.084,P=0.680,P=0.227,P = 0.247,P = 0.128).The characteristics of the colonoscopy procedure included the length of cecal intubation,the length of the cecum and ascending colon,IT,WT,bowel preparation quality,NRS,polyp detected,and adenoma detected.There were no significant differences statistically between the two groups(P=0.864,P=0.754,P=0.700,P=0.974,P=0.585,P=0.835,P=0.373,P=0.489).The characteristics of polyp included the first detected and missed polyps,the first detected and missed adenomas.There were no significant differences statistically between the two groups(P=0.053,P=0.361).Conclusions: This pre-test study found that repeated examinations of colonoscopy with a "cecal retroflexion observed" intervention could not detect more missed lesions and reduce lesion miss rate of the proximal colon compared to conventional forward repeated examinations.Therefore,colonoscopy cecal retroflexion observed may not have much significance for lesion missing in the proximal colon,but further conclusions require a prospective study with a higher level of evidence.Clinical Trials.gov ID:NCT03355443Ethics Approval Number:CHEC2017-142... |
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