Talens, M. (Marjolijn) (2013) Practice variation in colonoscopy and colonoscopy quality indicators. A prospective single-center evaluation. thesis, Medicine.
![[img]](https://umcg.studenttheses.ub.rug.nl/style/images/fileicons/text.png) |
Text
TalensM.pdf Restricted to Registered users only Download (648kB) |
Abstract
Background: Colorectal adenomas are the precursor lesions of colorectal carcinoma and may be easily overlooked during colonoscopy, leading to miss rates of up to 26%. Important colonoscopy quality indicators are the adenoma detection rate (ADR), i.e. the percentage of colonoscopies in which at least one adenoma is sent for pathology and the mean number of adenomatous polyps per colonoscopy (MAP). There are limited data on the relationship between variations in colonoscopy technique and these important quality indicators. Objective: To investigate the relationship between variation in colonoscopy technique and adenoma/advanced lesion detection. Design: A single-center prospective study. Setting: A non-academic teaching hospital. Patients: Patients who were routinely referred and accepted for either a diagnostic or screening colonoscopy. Main outcome measurements: Mean number of adenomatous polyps per colonoscopy (MAP) and mean number of advanced lesions per colonoscopy (MAL). Results: The MAP per endoscopist ranged from 0.17 to 0.65 (p = 0.219) and the MAL from 0.08 to 0.19 (p = 0.698). Indicators for a difficult introduction; use of the stiffner, the existence of a double-handed period, use of abdominal compressions, percentage of colonoscope looping, number of dynamic position changes, mean introduction time, patient pain score and adjustment of midazolam and phentanyl dose were significantly different between the endoscopists (p-values < 0.005). The correlations between abdominal distension during withdrawal and MAP and between mean removal time per adenoma per endoscopist and MAP were significant. The correlations between indicators for a difficult introduction and MAP and MAL were not significant. Limitations: Single-center study on colonoscopies performed by only 10 endoscopists. Conclusion: Despite the differences in colonoscopy technique during introduction between endoscopists, there were no significant differences in the colonoscopy quality indicators MAP and MAL. Nonetheless, there were significant differences in patient pain score. Patient pain score could be regarded as another important quality indicator for colonoscopy. Factors associated with MAP during withdrawal, given sufficient withdrawal times, were the distention of the bowel during inspection, and the skill to remove polyps quickly.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Borg, Frank ter and Deventer Hospital and Department of Gastroenterology and and Hepatology |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:55 |
| Last Modified: | 25 Jun 2020 10:55 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1598 |
Actions (login required)
 |
View Item |