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首页> 外文期刊>Endoscopy International Open >Practice patterns and predictors of prophylactic endoscopic clip usage during polypectomy
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Practice patterns and predictors of prophylactic endoscopic clip usage during polypectomy

机译：息肉切除术中预防性内镜夹使用的实践模式和预测因素

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Background and study aims?Prophylactic endoscopic clips are commonly placed during polypectomy to reduce risk of delayed bleeding, although evidence to support this practice is unclear. Our study aimed to: (1) identify variables associated with prophylactic clip use; (2) explore variability between endoscopists’ clipping practices and (3) study temporal trends in prophylactic clip use. Patients and methods?This was a retrospective cohort study in a high-volume unit dedicated to screening-related colonoscopies. Colonoscopies involving polypectomy from 2008 to 2014 were reviewed. The primary outcome was prophylactic clipping status, both at the patient level and per polyp.?Hierarchical regression models yielded adjusted odds ratios (AORs) to determine predictors of prophylactic clipping. Results?A total of 8,366 colonoscopies involving 19,129 polypectomies were included. Polyp size ≥?20?mm was associated with higher clip usage (AOR 2.94; 95?% CI: 2.43, 3.54) compared to polyps ?10?mm. Right-sided polyps were more likely to be clipped (AOR 2.78; 95?% CI: 2.34, 3.30) relative to the rectum. Surgeons clipped less than gastroenterologists (OR 0.52; 95?% CI: 0.44, 0.63). From 2008 to 2014, the crude proportion of prophylactically clipped cases increased by 7.4?% (95?% CI: 7.1, 7.6) from 1.9?% to 9.3?%. Significant inter-endoscopist variability in clipping practices was observed, notably, for polyps ?10?mm. Conclusions?Prophylactic clip usage was correlated with established risk factors for delayed bleeding. Significantly increased clip usage over time was shown. Given that evidence does not clearly support prophylactic clipping, there is a need to educate practitioners and limit healthcare resource utilization.
机译：背景和研究目的：在息肉切除术中通常放置预防性内窥镜夹子以减少延迟出血的风险，尽管尚不清楚支持这种做法的证据。我们的研究旨在：（1）识别与预防性使用夹子相关的变量; （2）探索内镜医师剪发习惯之间的差异，以及（3）研究预防性剪发使用的时间趋势。患者和方法？这是一项回顾性队列研究，在一个大批研究筛查相关结肠镜检查的部门进行。回顾了2008年至2014年涉及息肉切除术的结肠镜检查。主要结果是在患者水平和每个息肉的预防性剪下状态。等级回归模型产生调整后的优势比（AOR），以确定预防性剪下的预测因子。结果：共纳入8366例结肠镜检查，涉及19129例多视镜检查。与<？10？mm的息肉相比，息肉尺寸≥？20？mm与更高的卡夹使用率相关（AOR 2.94; 95 %% CI：2.43、3.54）。相对于直肠，右侧息肉更有可能被夹住（AOR 2.78; 95％CI：2.34、3.30）。外科医生的割伤率少于胃肠病医生（OR 0.52; 95％CI：0.44、0.63）。从2008年到2014年，预防性切除病例的原始比例从1.9％增加到9.3％（上升7.4％）（95％CI：7.1、7.6）。观察到内窥镜检查者在修剪操作中存在明显的变异性，尤其是对于<？10？mm的息肉。结论：预防性使用夹子与确定的延迟出血危险因素相关。随着时间的推移，剪辑的使用率显着增加。鉴于证据不能明确支持预防性剪裁，因此需要对从业人员进行教育并限制医疗资源的利用。

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