Background and Aims

The use of forceps for removal of nondiminutive polyps is associated with incomplete resection compared with snare polypectomy. However, few studies have characterized the frequency of forceps polypectomy for nondiminutive polyps or identified strategies to improve this practice. To address this gap, we estimated the prevalence and predictors of forceps polypectomy in clinical practice and examined the effectiveness of a multicomponent intervention to reduce inappropriate forceps polypectomy.

Methods

We retrospectively reviewed all colonoscopies with polypectomies performed at 2 U.S. health systems between October 1, 2017, and September 30, 2019. We used a mixed-effects logistic regression model to examine the effect of a multicomponent intervention, including provider education and a financial incentive, to reduce inappropriate forceps polypectomy, defined as use of forceps polypectomy for polyps ≥5 mm.

Results

A total of 9968 colonoscopies with 25,534 polypectomies were performed by 42 gastroenterologists during the study period. Overall, 8.5% (n = 2176) of polyps were removed with inappropriate forceps polypectomy. Inappropriate forceps polypectomy significantly decreased after the intervention (odds ratio [OR], 0.34, 95% confidence interval [CI], 0.30–0.39), from 11.4% (n = 1539) to 5.3% (n = 637). Predictors of inappropriate forceps polypectomy included inadequate bowel prep (OR, 1.25; 95% CI, 1.06–1.47), polyps in the right colon (vs left: OR, 1.29; 95% CI, 1.09–1.51), and number of polyps removed (OR, 0.96; 95% CI, 0.94–0.97). Inappropriate forceps polypectomy also varied by gastroenterologist (median OR, 3.43). In a post hoc analysis, the proportion of polyps >2 mm removed with forceps decreased from 50.0% before the intervention to 43.0% after it (OR, 0.62; 95% CI, 0.58–0.68).

Conclusions

Inappropriate forceps polypectomy is common but modifiable. The proportion of nondiminutive polyps removed with forceps polypectomy should be considered as a quality measure.

中文翻译：

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非小息肉钳息肉切除术的流行率很高，但可以改变

背景和目标

与圈套器息肉切除术相比，使用镊子切除非小型息肉会导致切除不完全。然而，很少有研究描述非小息肉钳息肉切除术的频率或确定改进这种做法的策略。为了解决这一差距，我们估计了临床实践中钳子息肉切除术的患病率和预测因素，并检查了多成分干预措施对减少不适当的钳子息肉切除术的有效性。

方法

我们回顾性审查了 2017 年 10 月 1 日至 2019 年 9 月 30 日期间在美国 2 个卫生系统进行的所有结肠镜检查和息肉切除术。我们使用混合效应逻辑回归模型来检查多成分干预的效果，包括提供者教育和经济激励，减少不适当的钳子息肉切除术，定义为使用钳子切除息肉≥5毫米的息肉。

结果

研究期间，42 名胃肠病学家总共进行了 9968 例结肠镜检查和 25,534 例息肉切除术。总体而言，8.5% (n = 2176) 的息肉因不适当的息肉钳切除术而被切除。干预后，不适当的钳子息肉切除术显着下降（比值比 [OR]，0.34，95% 置信区间 [CI]，0.30-0.39），从 11.4% (n = 1539) 降至 5.3% (n = 637)。不适当的镊子息肉切除术的预测因素包括肠道准备不足（OR，1.25；95% CI，1.06-1.47）、右结肠息肉（相对于左结肠：OR，1.29；95% CI，1.09-1.51）以及切除的息肉数量（OR，0.96；95% CI，0.94–0.97）。不合适的钳子息肉切除术也因胃肠病学家的不同而不同（中位 OR，3.43）。在事后分析中，用镊子切除>2毫米息肉的比例从干预前的50.0%下降到43%。

结论

不适当的钳子息肉切除术很常见，但可以修改。用镊子息肉切除术切除的非小型息肉的比例应被视为质量衡量标准。