Külling Daniel, Christ Andreas D, Karaaslan Nidayi, Fried Michael, Bauerfeind Peter
Department of Internal Medicine, University Hospital of Zurich, Switzerland.
Swiss Med Wkly. 2002 Mar 23;132(11-12):139-42. doi: 10.4414/smw.2002.09877.
To assess whether patient or adenoma characteristics at index colonoscopy could be predictors of metachronous adenomas and of advanced metachronous adenomas at first surveillance colonoscopy.
This retrospective study evaluated polypectomies of 372 adenomas in 214 patients who underwent a first follow-up colonoscopy after a median of 17 months. Logistic regression analysis was used to assess the association of baseline patient and adenoma characteristics with the development of any metachronous adenomas and of advanced adenomas (>1.0 cm, or villous component, or severe dysplasia, or early cancer).
Eighty-one patients (38%) demonstrated 130 metachronous adenomas including 21 cases (10%) with advanced adenomas. The presence of more than 2 baseline adenomas was significantly associated with the finding of adenomas at follow-up (odds ratio 2.44, 95% confidence interval 1.27-4.68, p = 0.010). Patient age (>or= 60 versus <60) and size of largest adenoma (>1.0 cm versus <or= 1.0 cm) demonstrated borderline significance. However, neither gender, most advanced histology (tubulo-villous/villous versus tubular), nor most advanced dysplasia (severe/early cancer versus mild/moderate) at baseline colonoscopy were related with the development of metachronous adenomas. Furthermore, none of the analysed patient and polyp characteristics demonstrated an association with the development of advanced metachronous adenomas.
Patients with over 2 adenomas at baseline colonoscopy are at highest risk for the finding of adenomas at follow-up.
评估初次结肠镜检查时的患者或腺瘤特征是否可作为异时性腺瘤以及首次监测结肠镜检查时进展期异时性腺瘤的预测指标。
这项回顾性研究评估了214例患者的372个腺瘤的息肉切除术，这些患者在中位时间17个月后接受了首次随访结肠镜检查。采用逻辑回归分析评估基线患者和腺瘤特征与任何异时性腺瘤及进展期腺瘤（>1.0 cm，或绒毛成分，或重度异型增生，或早期癌症）发生之间的关联。
81例患者（38%）出现130个异时性腺瘤，其中21例（10%）为进展期腺瘤。基线腺瘤超过2个与随访时发现腺瘤显著相关（比值比2.44，95%置信区间1.27 - 4.68，p = 0.010）。患者年龄（≥60岁与<60岁）和最大腺瘤大小（>1.0 cm与≤1.0 cm）显示出临界显著性。然而，基线结肠镜检查时的性别、最严重组织学类型（管状绒毛状/绒毛状与管状）以及最严重异型增生程度（重度/早期癌症与轻度/中度）均与异时性腺瘤的发生无关。此外，所分析的患者和息肉特征均未显示与进展期异时性腺瘤的发生存在关联。
基线结肠镜检查时腺瘤超过2个的患者在随访时发现腺瘤的风险最高。
