智能消化内镜质控系统在结肠镜检查中的应用研究

Application of intelligent performance measurement system for gastrointestinal endoscopy to colonoscopy

目的评估智能消化内镜质控系统在结肠镜检查中的质量监控作用。方法根据纳入排除标准, 将来自武汉大学人民医院内镜中心的9名内镜医师按随机数字法随机分配到质控组和对照组。质控前阶段(2019年4月20日—2019年5月31日)收集入组内镜医师进行的结肠镜检查资料。质控培训阶段(2019年6月1—30日)质控组内镜医师培训质控相关知识和智能消化内镜质控系统的使用说明;对照组内镜医师仅培训质控相关知识。质控后阶段(2019年7月1日—2019年8月20日)每周给质控组内镜医师反馈质控报告, 而对照组内镜医师无质控报告。收集两组内镜医师结肠镜检查资料。主要终点为腺瘤检出率, 次要终点为退镜时间、息肉检出率、达盲率。结果 9名内镜医师中, 质控组4名, 对照组5名。质控前阶段和质控后阶段共纳入结肠镜检查1 471例。质控组的腺瘤检出率及息肉检出率在质控后提高[13.7%(45/329)比7.1%(24/338),χ2=55.796, P<0.001;48.9%(161/329)比40.2%(136/338), χ2=4.071, P=0.044], 退镜时间较质控前增加[5.9(3.9, 7.3)min比4.1(2.8, 6.1)min, Z=6.965, P<0.001]。而对照组质控后阶段与质控前阶段以上指标比较差异均无统计学意义[9.3%(37/398)比9.1%(37/406),χ2=0.329, P=0.566;33.9%(135/398)比33.0%(134/496),χ2=3.616, P=0.057;3.9(2.7, 6.1)min比3.6(2.6, 5.8)min, Z=1.355, P=0.175]。结论智能消化内镜质控系统结合审查和反馈模式可以实现对内镜医师结肠镜检查的质控作用, 并提高内镜医师的结肠镜检查质量。

Objective To evaluate the intelligent performance measurement system for colonoscopy.Methods Nine endoscopists from Renmin Hospital of Wuhan University were randomly assigned to the quality control group and the control group based on inclusion and exclusion criteria by the random number table.In the pre-quality-control stage(from April 20,2019 to May 30,2019),colonoscopic data acquired by the enrolled endoscopists were collected.In the training stage(June 1-30,2019),the quality control group was trained on the quality control knowledge and the use of intelligent gastrointestinal endoscopy performance measurement system;but the control group was only trained on the quality control knowledge.In the post-quality-control stage(from July 1,2019 to August 20,2019),a weekly quality feedback was given to endoscopists of the quality control group,while the endoscopists of the control group had no quality control report.Then,the colonoscopic data acquired by enrolled endoscopists were prospectively collected during the period.The primary endpoint was adenoma detection rate.The secondary endpoints were withdrawal time,polyp detection rate and cecal intubation rate.Results Four endoscopists were assigned to the quality control group and five to the control group.A total of 1471 colonoscopic procedures were analyzed.The detection rates of adenoma and polyp in the quality control group increased with feedbacks[13.7%(45/329)VS 7.1%(24/338),χ2=55.796,P<0.001;48.9%(161/329)VS 40.2%(136/338),χ2=4.071,P=0.044],while there were no significant differences in the control group[9.3%(37/398)VS 9.1%(37/406),χ2=0.329,P=0.566;33.9%(135/398)VS 33.0%(134/496),χ2=3.616,P=0.057].The withdrawal time in the quality control group increased with feedbacks[5.9(3.9,7.3)min VS 4.1(2.8,6.1)min,Z=6.965,P<0.001],while there was no significant difference in this variable in the control group[3.9(2.7,6.1)min VS 3.6(2.6,5.8)min,Z=1.355,P=0.175].Conclusion The intelligent performance measurement system for gastrointestinal endoscopy with feedbacks can monitor and improve the colonoscopic quality.