Winawer S J, Stewart E T, Zauber A G, Bond J H, Ansel H, Waye J D, Hall D, Hamlin J A, Schapiro M, O'Brien M J, Sternberg S S, Gottlieb L S
Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
N Engl J Med. 2000 Jun 15;342(24):1766-72. doi: 10.1056/NEJM200006153422401.
After patients have undergone colonoscopic polypectomy, it is uncertain whether colonoscopic examination or a barium enema is the better method of surveillance.
As part of the National Polyp Study, we offered colonoscopic examination and double-contrast barium enema for surveillance to patients with newly diagnosed adenomatous polyps. Although barium enema was performed first, the endoscopist did not know the results.
A total of 973 patients underwent one or more colonoscopic examinations for surveillance. In the case of 580 of these patients, we performed 862 paired colonoscopic examinations and barium-enema examinations that met the requirements of the protocol. The findings on barium enema were positive in 222 (26 percent) of the paired examinations, including 139 of the 392 colonoscopic examinations in which one or more polyps were detected (rate of detection, 35 percent; 95 percent confidence interval, 31 to 40 percent). The proportion of examinations in which adenomatous polyps were detected by barium enema colonoscopy was significantly related to the size of the adenomas (P=0.009); the rate was 32 percent for colonoscopic examinations in which the largest adenomas detected were 0.5 cm or less, 53 percent for those in which the largest adenomas detected were 0.6 to 1.0 cm, and 48 percent for those in which the largest adenomas detected exceeded 1.0 cm. Among the 139 paired examinations with positive results on barium enema and negative results on colonoscopic examination in the same location, 19 additional polyps, 12 of which were adenomas, were detected on colonoscopic reexamination.
In patients who have undergone colonoscopic polypectomy, colonoscopic examination is a more effective method of surveillance than double-contrast barium enema.
患者接受结肠镜息肉切除术后，不确定结肠镜检查或钡剂灌肠哪种是更好的监测方法。
作为国家息肉研究的一部分，我们为新诊断为腺瘤性息肉的患者提供结肠镜检查和双重对比钡剂灌肠进行监测。虽然先进行了钡剂灌肠，但内镜医师不知道结果。
共有973例患者接受了一次或多次结肠镜检查进行监测。在其中580例患者中，我们进行了862次符合方案要求的配对结肠镜检查和钡剂灌肠检查。在配对检查中，钡剂灌肠检查结果为阳性的有222例（26%），包括在392次检测到一个或多个息肉的结肠镜检查中的139例（检测率为35%；95%置信区间为31%至40%）。钡剂灌肠结肠镜检查检测到腺瘤性息肉的检查比例与腺瘤大小显著相关（P = 0.009）；检测到的最大腺瘤为0.5 cm或更小的结肠镜检查的检测率为32%，检测到的最大腺瘤为0.6至1.0 cm的为53%，检测到的最大腺瘤超过1.0 cm的为48%。在同一部位钡剂灌肠检查结果为阳性而结肠镜检查结果为阴性的139例配对检查中，结肠镜复查又检测到19个额外的息肉，其中12个为腺瘤。
在接受结肠镜息肉切除术后的患者中，结肠镜检查是比双重对比钡剂灌肠更有效的监测方法。
