英国症状性胃镜的诊断产量:英国胃肠病学学会使用国家内镜数据库的数据进行分析
David Robert Beaton1,2, Linda Sharp2, Liya Lu2
1Northumbria Healthcare NHS Foundation Trust, North Shields, UK dbeaton1@nhs.net.
Gut
|May 2, 2024
概括
大多数患者,特别是50岁以下的患者,胃镜诊断癌症的收益率很低. 超过70%的手术是在低风险个体上进行的,这表明癌症检测资源使用效率低下.
科学领域:
- 胃肠病学 胃肠病学
- 诊断性收益率分析
- 医疗保健资源管理 医疗保健资源管理
背景情况:
- 胃镜检查是检查胃肠道症状的常见方法.
- 优化胃镜诊断产量对于有效的医疗保健资源分配至关重要.
- 了解症状特异性产量可以改善患者的选择,减少不必要的手术.
研究的目的:
- 在一个大型的国家队列中确定胃镜检查常见症状的诊断收益率.
- 为了确定患有癌症或巴雷特食道 (BO) 诊断的可能性最高的患者组.
- 根据诊断产量评估当前胃镜利用的效率.
主要方法:
- 一项横截面研究分析了来自英国国家内镜数据库 (2019年3月至2020年2月) 的382,370例诊断性胃镜.
- 混合效应逻辑回归模型被用于计算癌症和BO的调整正预测值 (aPPVs).
- 模型将患者的症状,年龄,性别和内镜医生作为变量.
主要成果:
- 癌症的整体aPPV很低 (1.0%),男性的产量更高 (1.7%) 和50岁以上的患有缺食症 (3.0%) 或体重减轻 (1.4%) 的患者.
- 对大多数症状和所有50岁以下的患者来说,癌症aPPVs低于1%.
- 73.7%的胃镜检查是在癌症aPPV低于1%的患者组中进行的.
- 巴雷特食道的整体aPPV为4.1%,反流症状的产量更高 (5.8%).
结论:
- 老年男性和50岁以上的男性患癌症时,胃镜检查的收益率最高,而50岁以上的男性患有诸如消化不良等特定症状时,则收益率最高.
- 显著大多数的胃镜检查是在低产量的患者群体中进行的,这表明资源利用率不够优.
- 根据症状特异性风险分层来定位胃镜,可以提高诊断效率和癌症检测率.
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