Avidan Benjamin, Sonnenberg Amnon, Schnell Thomas G, Leya Jack, Metz Adrienne, Sontag Stephen J
Department of Veterans Affairs Medical Center, Albuquerque, New Mexico 87108, USA.
Am J Gastroenterol. 2002 Jun;97(6):1524-9. doi: 10.1111/j.1572-0241.2002.05801.x.
The fear that colorectal adenomas were missed on initial colonoscopy or that new adenomas have developed is often a rationale for repeating a colonoscopic examination. The aim of this study was to delineate risk factors associated with recurrence of colorectal adenomas after an initial baseline screening colonoscopy.
The study population comprised 875 subjects who underwent a baseline screening colonoscopy followed by a second examination 1-5 yr later. Multiple logistic regression was used to assess the influence of potential risk factors on the occurrence or recurrence of colorectal adenomas, the strength of the influence being expressed as an OR with a 95% CI.
Colorectal adenomas were detected in 484 of all patients (55%) at baseline colonoscopy. Within a 1- to 5-yr time interval, 181 patients (37%) had recurrent adenomas (adenomas were removed during the first colonoscopy) and 73 patients (19%) had newly developed adenomas (adenomas were absent on the first colonoscopy). The occurrence of adenomas at baseline screening colonoscopy was the only factor associated with an increased risk for the recurrence of adenomas at follow-up (OR = 2.51, 95% CI = 1.77-3.55). Recurrence was associated with multiple baseline adenomas (4.45, 2.98-6.64) and baseline adenomas larger than 1 cm (2.62, 1.99-3.11). Recurrence was not associated with histology type or family history of colorectal cancer. There was a significant trend for adenomas to recur in the same proximal or distal segment as the baseline adenomas (p = 0.02).
Colon adenomas tend to recur with greater frequency if the adenomas removed at baseline were either large or multiple. Although patients with large adenomas or multiple adenomas at baseline screening colonoscopy are at a 2.6- to 4.5-fold risk for recurrence of adenomas, the rate of de novo adenoma formation in patients without baseline adenomas may be large enough to warrant repeat colonoscopy at some time in the future. The exact timing of the follow-up colonoscopy needs to be determined.
担心初次结肠镜检查时漏诊结直肠腺瘤或出现新的腺瘤，常常是重复进行结肠镜检查的一个理由。本研究的目的是确定初次基线筛查结肠镜检查后结直肠腺瘤复发的相关危险因素。
研究人群包括875名接受了基线筛查结肠镜检查且在1至5年后进行了第二次检查的受试者。采用多因素logistic回归分析来评估潜在危险因素对结直肠腺瘤发生或复发的影响，影响强度以OR及95%CI表示。
在基线结肠镜检查时，484例患者（55%）检测到结直肠腺瘤。在1至5年的时间间隔内，181例患者（37%）出现腺瘤复发（腺瘤在首次结肠镜检查时已切除），73例患者（19%）出现新发腺瘤（首次结肠镜检查时无腺瘤）。基线筛查结肠镜检查时腺瘤的出现是随访时腺瘤复发风险增加的唯一相关因素（OR = 2.51，95%CI = 1.77 - 3.55）。复发与多个基线腺瘤（4.45，2.98 - 6.64）以及基线时直径大于1 cm 的腺瘤（2.62，1.99 - 3.11）相关。复发与组织学类型或结直肠癌家族史无关。腺瘤在与基线腺瘤相同的近端或远端节段复发有显著趋势（p = 0.02）。
如果基线时切除的腺瘤体积大或为多个，结肠腺瘤往往更容易复发。尽管基线筛查结肠镜检查时患有大腺瘤或多个腺瘤的患者腺瘤复发风险为2.6至4.5倍，但无基线腺瘤患者的新发腺瘤发生率可能高到足以保证在未来某个时间重复进行结肠镜检查。后续结肠镜检查的确切时间需要确定。
