Evolução da prática da colonoscopia num hospital distrital

 

M. Isabelle Cremers¹, P. Marques Vidal², F. Augusto¹, A. Luísa Alves¹, C. Pinho¹, C. Lobato¹, É. Gamito¹, V. Fernandes¹, R. Freire¹, A. Paula Oliveira¹

 

Resumo

Objectivos: Analisar a evolução da prática da colonoscopia na Unidade de Endoscopia do Hospital São Bernardo. Metodologia: Análise retrospectiva das colonoscopias efectuadas em 1997 (ano que precedeu o lançamento da Campanha de Rastreio do Cancro Colorrectal pela Sociedade Portuguesa de Endoscopia Digestiva) e 2003 (ano da inauguração das novas instalações da Unidade de Endoscopia). Foram considerados: sexo, idade, proveniência dos doentes, indicações para o exame, uso de sedação, nível do cólon atingido, qualidade da preparação intestinal, diagnósticos e tratamentos efectuados.

Resultados: Em 1997 e em 2003 foram efectuadas, respectivamente, 917 e 1207 colonoscopias. Em 2003, os doentes foram referenciados mais frequentemente pelo Serviço de Gastrenterologia (60% vs. 40%, em 1997, p<0,001); um maior número foi sedado (25% vs. 5%, p<0,001) e apresentavam uma melhor qualidade da preparação intestinal (boa qualidade: 54% vs. 40%, p<0,001); também se verificou uma maior frequência de colonoscopias com indicação correcta (70% vs. 64%, p<0,01) e menos doentes submetidos a colonoscopia em regime de internamento (21% vs. 34%, p<0,001) e de urgência (18% vs. 26%, p<0,001). A frequência do rastreio aumentou significativamente, passando de 1,3% para 8,8% dos exames (p<0,001). Em contrapartida, não foram encontradas diferenças na percentagem de colonoscopias totais (73% vs. 71% em 1997), normais (37% em ambos os anos) ou nos motivos para colonoscopia incompleta.

Conclusões: O lançamento da Campanha de Rastreio do cancro colorrectal e as mudanças introduzidas na organização e funcionamento da Unidade de Endoscopia, após a inauguração das novas instalações, tiveram um impacto benéfico na prática da colonoscopia no Serviço de Gastrenterologia do Hospital São Bernardo.

 

Summary

Objective: To characterise the evolution of colonoscopy practice in the Endoscopy Unit of Hospital São Bernardo. Methods: A retrospective study in patients who underwent colonoscopy in 1997 (the year prior to the launch of the Portuguese Society of Digestive Endoscopy’s colorectal cancer screening campaign) and in 2003 (the year the Endoscopy Unit’s new facilities were inaugurated). Data collected included: patient gender, age and geographical origin; whether the procedure was ambulatory or inpatient, routine or emergency, the quality of the bowel prep, whether or not sedation was used, informed consent, indication, extent of the visualization of the colon and final outcome (endoscopic and histological). The indications were also compared with ASGE recommendations.

Results: In 1997 and in 2003, 917 and 1207 colonoscopies, respectively, were performed. In 2003, the patients were more often referred from the Gastroenterology Department (60% vs. 40%, in 1997, p < 0.001); a greater number of patients were sedated in 2003 (25% vs. 5%, p < 0.001). In 2003 the patients had better intestinal preparation good quality: 54% vs. 40%, p < 0.001). In addition, a greater number of the colonoscopies were done based on a correct indication according to ASGE (70% vs. 64%, p < 0.01) and fewer patients underwent colonoscopy as inpatients (21% vs. 34%, p < 0.001) and fewer exams were urgent (18% vs. 26%, p < 0.001). The frequency of the screening increased significantly, accounting for 1,3% of exams in 1997 and 8,8% in 2003 (p < 0.001). However, we found no differences in the percentage of total colonoscopies (73% vs. 71% in 1997), normal exams (37% in both years) or the reasons for incomplete colonoscopy.

Conclusions: The start of the colorectal screening campaign and changes made in the organization of the Endoscopy Unit, after the inauguration of the new facilities, had a positive impact on colonoscopy practice in the Gastrenterology Department of Hospital São Bernardo.

 

 

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Correspondência:

Marie Isabelle Cremers

Serviço de Gastrenterologia

Hospital de São Bernardo

Rua Camilo Castelo Branco

2910-446 Setúbal

Tel.: 265 54 90 55

Fax: 212 31 09 39

e-mail: cremers_tavares@hotmail.com

 

(1) Serviço de Gastrenterologia, Hospital de São Bernardo, Setúbal, Portugal.

(2) Centro de Nutrição e Metabolismo, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Portugal.

 

Recebido para publicação: 30/05/2007

Aceite para publicação: 31/10/2007