圈套器辅助评估肠道息肉长径的面对面问卷调查研究

A face‑to‑face questionnaire survey on snare‑assisted long diameter assessment of intestinal polyps

摘要:

目的 探讨使用圈套器辅助评估肠道息肉长径的价值。方法 构建2个长径7 mm、11 mm的息肉模型并置入肠道模型内，拍摄息肉中、近景图片以及辅助使用圈套器后的息肉图片。使用拍摄的息肉图片，对多家医院的结肠镜医师逐个进行面对面的问卷调查。主要观察指标为单纯肉眼或圈套器辅助评估息肉长径的相对准确度。次要观察指标为医师判断长径±1.0 mm范围的准确率，低估、高估息肉长径的比例，长径7 mm息肉误判为≥10 mm、误判为≤5 mm、11 mm息肉误判为<10 mm的比例。结果 2023年5月—12月来自15家公立三级医院的128名结肠镜医师参与了本项问卷调查。结肠镜医师使用圈套器辅助评估长径比单纯肉眼判断的相对准确度更高（7mm息肉：84.7%比77.5%，Z=-4.12，P<0.001；11 mm息肉：87.2%比79.2%，Z=-4.70，P<0.001）。使用圈套器辅助评估息肉长径±1.0 mm范围的准确率高于单纯肉眼判断［7 mm息肉：83.6%（107/128）比59.4%（76/128），χ²=18.42，P<0.001；11 mm息肉：75.8%（97/128） 比51.5%（66/128），χ²=16.23，P<0.001］，可降低低估比例［7 mm息肉：6.3%（8/128）比28.1%（36/128），χ²=21.52， P<0.001；11 mm息肉：10.9%（14/128）比35.2% （45/128），χ²=21.27，P<0.001］，高估则差异无统计学意义［7 mm息肉：10.1%（13/128）比12.5%（16/128），χ²=0.35， P=0.554；11 mm息肉：13.3%（17/128）比13.3%（17/128），χ²=0.00，P=1.000］。使用圈套器辅助评估可明显降低医师单纯肉眼将长径7 mm息肉误判为≤5 mm［6.3%（8/128）比28.1%（36/128），χ²=21.52，P<0.001］或≥10 mm的比例［5.5%（7/128）比12.5%（16/128），χ²=3.87，P=0.049］，以及将长径11 mm息肉误判为<10 mm的比例 ［10.9%（14/128）比35.2%（45/128），χ²=21.27，P<0.001］。结论 结肠镜医师单纯肉眼评估息肉长径倾向于低估息肉长径，通过辅助使用圈套器，可以显著提高息肉长径评估的准确率，有利于选择恰当的内镜切除技术，并指导随访。

Abstract:

Objective To evaluate snare assistance in the long diameter assessment of intestinal polyps. Methods Two polyp models with a long diameter of 7 mm and 11 mm were constructed and inserted into the intestinal model. Close‑up and medium‑shot images of polyps were obtained both with and without a snare positioned adjacent to each polyp. A face-to-face questionnaire survey of colonoscopists from multiple hospitals was conducted who were asked to estimate polyp long diameter under each viewing condition. The primary outcome was the relative accuracy of long diameter evaluation by visual assessment alone versus with snare assistance. Secondary outcomes included proportions of underestimation, overestimation, and estimates within ±1.0 mm of actual long diameter, as well as misclassification rates for 7 mm polyps as ≤5 mm or ≥10 mm, and for 11 mm polyps as <10 mm. Results From May to December 2023, 128 colonoscopists from 15 public tertiary hospitals participated in this questionnaire survey. The relative accuracy of snare-assisted evaluation was significantly higher than that of the visual assessment (7 mm: 84.7% VS 77.5%, Z=-4.12, P<0.001;11 mm: 87.2% VS 79.2%, Z=-4.70, P<0.001). The accuracy of estimates within ± 1.0 mm range was higher with snare assistance [7 mm: 83.6% (107/128) VS 59.4% (76/128), χ²=18.42, P<0.001; 11 mm: 75.8% (97/128) VS 51.5% (66/128), χ²=16.23, P<0.001], while underestimation was significantly reduced [7 mm: 6.3% (8/128) VS 28.1% (36/128), χ²=21.52, P<0.001; 11 mm: 10.9% (14/128) VS 35.2% (45/128), χ²=21.27, P<0.001], and no significant difference was observed in overestimation [7 mm: 10.1% (13/128) VS 12.5% (16/128), χ²=0.35, P=0.554; 11 mm: 13.3% (17/128) VS 13.3% (17/128), χ²=0.00, P=1.000]. Snare assistance also significantly reduced misclassification of 7 mm polyps as ≤5 mm [6.3% (8/128) VS 28.1% (36/128), χ²=21.52, P<0.001] or ≥10 mm [5.5% (7/128) VS 12.5% (16/128), χ²=3.87, P=0.049] and of 11 mm polyps as <10 mm [10.9% (14/128) VS 35.2% (45/128), χ²=21.27, P<0.001]. Conclusion Colonoscopists tend to underestimate the long diameter of polyps. Snare-assisted measurement significantly improves long diameter estimation accuracy, facilitating appropriate selection of resection techniques and guiding post-polypectomy surveillance.