| Objective: To determine the detection rate of adenoma as an important index for quality control of colonoscopy.By improving the quality of colonoscopy and finding more adenomas,endoscopic resection can reduce the incidence of colorectal cancer.Methods: Choose Two endoscopic physicians with different endoscopic operation time,operation experience,adenoma recognition ability and endoscopic withdrawal time.Analyze a total of 1188 patients who visited the endoscopy center of a third-class A hospital for the first time from October 2018 to October 2019.Statistics of the general condition of the patient(age,gender,etc.),bowel preparation,time of withdrawal,anesthesia,diseased location and other influencing factors.Using pathological results as the gold standard for diagnosis,the adenoma detection rates of two endoscopists with different years of experience were collected,and the differences in adenoma detection and clinical characteristics between the two groupswerecompared.Results:1.The total ADR of senior physicians(23.55%)was higher than that of junior physicians(22.69%),and the average ADR was 23.12%.The total PDR of senior physicians(41.43%)was higher than that of junior physicians(38.65%).The ADRs of both physicians were slightly lower than those recommended by the American Society of Digestive Endoscopy guidelines(2015).In this study,the effects of physician seniority,patient gender,patient age,withdrawal time and intestinal preparation on ADR were compared.According to the analysis of variance,it is found that different years of experience have no statistically significant impact on ADR(P = 0.276).ADR was correlated with patient gender,patient age,withdrawal time,and intestinal preparation.2.Male patients with ADR was 29.07% on average,women with an average ADR was 17.43%,Compared with the guideline recommended by the American Society of Digestive Endoscopy(2015),the ADR of male and female in the endoscopy center of a third-class A hospital was slightly lower than the guideline recommended,Compared with the results published in Changhai Hospital(2014),the ADR of two physicians in the endoscopy center of a third-class A hospital was much higher than that of Changhai Hospital.According to logistics regression analysis,the OR value of patients’ gender was 2.125,and the difference was statistically significant(P < 0.001).It can be concluded that the ADR of male is 2.125 times that of female.Compared with female,male sex is more prone to adenoma.3.The mean ADR of patients with age < 45 years old was 12.37%,the mean ADR of patients with age 45-55 years old was 21.66%,and the mean ADR of patients with age > years old was 34.99%.Compared with the US guidelines,the ADR of the endoscopy center of a class tertiary hospital with an age>55 years old is higher than recommended by the guidelines(ADR>25%).Through logistics regression analysis,According to logistics regression analysis,the OR value of patients’ age was1.049,P < 0.001,and the difference was statistically significant.It can be concluded that the risk of adenoma increases by 4.9% for every 1 year increase in age,and the occurrence of adenoma is positively correlated with age.4.This study showed that 93.63% of patients in the high seniority group had excellent intestinal preparation,and 94.33% of patients in the low seniority group had excellent intestinal preparation,Two physicians in the endoscopy center of a third-grade hospital had excellent bowel preparation above the recommended standards of the United States guidelines.The mean ADR of the poor intestinal preparation group was8.83%,the mean ADR of the inadequate intestinal preparation group was 18.85%,and the mean ADR of the adequate intestinal preparation group was 26%.By statistical analysis,patients with excellent bowel preparation were compared with patients with poor bowel preparation,The OR value was 1.846,P < 0.001,the difference was statistically significant,and the ADR was 1.846 times.The more fully prepared the intestinal tract,the higher the ADR of the patients,and vice versa.5.In this study,the percentages of adenomas with sizes ≤0.5cm,0.6cm-1.0cm,1.1cm-2.0cm and > 2.0cm were 69.34%,18.25%,8.39% and 4.02%,respectively.The most common pathological types in the four groups were tubular adenoma(94.21%),tubular adenoma(90%),tubular adenoma(69.57%),tubular adenoma and mixed adenoma(45.45%).The most common pathological type of all adenomas was tubular adenoma,accounting for 89.42%,and the most common morphological type of Yamada type I,accounting for 51.09%.The average ADR of endoscopic withdrawal time < 6 minutes was 16.76%,the average ADR of 6-9 minutes was 31.04%,and the average ADR of >9 minutes was 44.58%.In this study,it was found that the ADR of withdrawal time < 6 minutes was the lowest,and the ADR of withdrawal time > 9minutes was significantly higher than that of the other two groups.According to logistics regression analysis,OR value was 1.788,P < 0.001,and the difference was statistically significant.The longer the withdrawal time,the higher the ADR.6.According to whether anesthesia is divided into anesthesia group and non-anaesthesia group.The average ADR of the anesthetic group was 20.12%,while that of the non-anesthetic group was 36.17%.In this study,the average ADR of the anesthetic group was lower than that of the non-anesthetic group.The difference was not statistically significant(P=0.528).7.In this study,the CIR of high seniorage was 99.03%,and the CIR of low seniorage was 99.10%.The CIR of the endoscopy center of a third-class A hospital was higher than that recommended by the American guidelines.The difference was not statistically significant(P=0.736).8.This study found that according to the location of the adenoma,the left colon accounted for 60.22%,the right colon accounted for 39.78%,and the left colon had more adenomas than the right colon.Conclusion: 1.The operation time of the endoscopy center of a class tertiary hospital has reached 5 years,and the colonoscopy ADR results obtained by physicians with no less than 1,000 colonoscopy cases per year are credible.This study considers that the colonoscopy quality control in the endoscopy center is at a relatively high level.2.Among the quality control indexes of colonoscopy,the indexes of bowel preparation,time of withdrawal,and cecal intubation rate of the endoscopy center of a class tertiary hospital are all at a relatively high level in China.among which the ADR of the group with adequate intestinal preparation was the highest,and the ADR of the group with withdrawal time > 9 minutes was the highest.The adenoma size ≤0.5cm group accounted for 69.34%,and the most common pathological type was tubular adenoma.The intestinal mucosa can be fully observed by extending the endoscopic withdrawal time.This study suggests that the endoscopic withdrawal time of colonoscopy for screening purposes should not be less than 9 minutes.3.The data in this study showed that the left colon adenoma(accounted for 60.22%)was higher than the right colon(accounted for 39.78%).We should pay attention to the observation of the right colon,and it is suggested that the screening of asymptomatic people should be performed with total colonoscopy.4.The average ADR of the 45-55 years old group is 21.66%,and the average ADR of the group older than 55 years old is 34.99%.This study suggested that the age of colonoscopy in asymptomatic people should be from 45 years old for screening purposes. |
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