【原】【罂粟摘要】结肠镜镇静类型与息肉检测之间的关系:一项基于登记的队列研究

结肠镜镇静类型与息肉检测之间的关系:一项基于登记的队列研究

贵州医科大学          麻醉与心脏电生理课题组

翻译：田明德      编辑：田明德    审校：曹莹

背景：结直肠癌是癌症相关死亡的主要原因。腺瘤和锯齿状息肉是结直肠癌的先兆，锯齿状息肉在结肠镜检查中更难被发现。使用丙泊酚与息肉检测之间的关系尚不清楚。作者研究了丙泊酚与轻度-中度镇静在结肠镜检查中对腺瘤和锯齿状息肉检测的相关性。

方法：这项回顾性队列研究使用了新罕布什尔州结肠镜注册中心的观察数据。纳入2015年1月1日至2020年2月28日期间进行筛查或监测结肠镜检查的年龄大于50岁的患者。排除诊断性检查、无镇静、病理学数据缺失和肠道准备不良。在校正协变量的同时，使用多变量逻辑回归来评估全样本中丙泊酚和中度镇静在息肉检测方面的差异。在一项限制性样本分析中使用了内镜医生水平的倾向评分调整和聚类，该分析包括内镜医生和丙泊酚镇静使用率在5%至95%之间的设施。

结果：在全样本中共分析了54063例结肠镜检查，在限制样本中分析了18998例。在全样本和限制样本中，使用丙泊酚的锯齿状息肉患病率显著高于中度镇静（24751例中的6066例；4661例中的1410例；30.3%[95%CI，28.9至31.6%]；14337例中的3690例；25.7%[95%CI，25.0至26.5%]）（29312例中的9957例；33.4%至34.5%]）。在全样本多变量logistic回归中，丙泊酚与较高的肿瘤（调整比值比，1.25[95%CI，1.21-1.29]）、腺瘤（比值比，1.07[95%CI、1.03-1.11]）和锯齿状息肉检测（比值比为1.51[95%CI和1.46-1.57]）相关。在限制性样本中，使用治疗加权倾向评分调整的逆概率和内镜水平的聚类，观察到锯齿状息肉的效应大小减弱但具有统计学意义（优势比，1.13[95%CI，1.07比1）。

结论：结肠镜检查期间丙泊酚镇静可能与锯齿状息肉的检测改善有关，但与腺瘤无关。

原始文献来源：Quaye AN, Hisey WM, Mackenzie TA, et al. Association between Colonoscopy Sedation Type and Polyp Detection: A Registry-based Cohort Study. Anesthesiology. 2024 Apr 17.

Association between Colonoscopy Sedation Type and Polyp Detection: A Registry-based Cohort Study

Abstract

Background: Colorectal cancer is a leading cause of cancer-related death. Adenomas and serrated polyps are precursors of colorectal cancer, with serrated polyps being more difficult to detect during colonoscopy. The relationship between propofol use and polyp detection remains unclear. The authors investigated the association of propofol-based versus mild-moderate sedation on adenoma and serrated polyp detection during colonoscopy.

Method: This retrospective cohort study used observational data from the New Hampshire Colonoscopy Registry. Patients aged greater than 50 yr with screening or surveillance colonoscopies between January 1, 2015, and February 28, 2020, were included. Exclusions were diagnostic examinations, no sedation, missing pathology data, and poor bowel preparation. Multivariate logistic regression was used to evaluate differences in polyp detection between propofol and moderate sedation in the full sample while adjusting for covariates. Propensity score adjustment and clustering at the endoscopist level were used in a restricted sample analysis that included endoscopists and facilities with between 5% and 95% propofol sedation use.

Results: A total of 54,063 colonoscopies were analyzed in the full sample and 18,998 in the restricted sample. Serrated polyp prevalence was significantly higher using propofol (9,957 of 29,312; 34.0% [95% CI, 33.4 to 34.5%]) versus moderate sedation (6,066 of 24,751; 24.5% [95% CI, 24.0 to 25.1%]) in the full sample and restricted samples (1,410 of 4,661; 30.3% [95% CI, 28.9 to 31.6%] vs. 3,690 of 14,337; 25.7% [95% CI, 25.0 to 26.5%]). In the full sample multivariate logistic regression, propofol was associated with higher neoplasm (adjusted odds ratio, 1.25 [95% CI, 1.21 to 1.29]), adenoma (odds ratio, 1.07 [95% CI, 1.03 to 1.11]), and serrated polyp detection (odds ratio, 1.51 [95% CI, 1.46 to 1.57]). In the restricted sample using inverse probability of treatment weighted propensity score adjustment and clustering at the endoscopist level, an attenuated but statistically significant effect size was observed for serrated polyps (odds ratio, 1.13 [95% CI, 1.07 to 1.19]), but not for adenomas (odds ratio, 1.00 [95% CI, 0.95 to 1.05]) or any neoplastic lesion (odds ratio, 1.03 [95% CI, 0.98 to 1.08])..

Conclusion: Propofol sedation during colonoscopy may be associated with improved detection of serrated polyps, but not adenomas.