Schoen Robert E
Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Am J Gastroenterol. 2003 Jun;98(6):1237-46. doi: 10.1111/j.1572-0241.2003.07492.x.
As colorectal cancer screening gains acceptance by the public, the use of colonoscopy will increase. The frequency of surveillance examinations after detection of an adenoma is one of the largest contributors to the cost of colorectal cancer screening. Ten years after the publication of the landmark National Polyp Study, the issue of when to perform surveillance examinations and how often to expect advanced findings remains acute. Current guidelines for surveillance vary across specialty organizations. Individuals with advanced adenomas are at increased risk for recurrent advanced adenomas. The impact of multiple nonadvanced adenomas or a single nonadvanced adenoma on subsequent risk of an advanced adenoma or cancer is less clear. Still less is known about findings on repeat examinations after an initial negative examination, whether after colonoscopy or sigmoidoscopy. The yield after a negative examination is an important consideration in determining the recommended interval for screening colonoscopy. For example, the data supporting a 10-yr interval for screening colonoscopy is only indirect. What little we do know about the yield after negative examinations comes from selected, nonrepresentative populations. Of concern, evidence from several polyp prevention trials demonstrates higher yields for subsequent cancer than would be expected, despite a relatively high use of surveillance procedures in follow-up. Further population-based research on the frequency of use and yield of surveillance examinations is needed. Studies that examine the need and the needed timing of subsequent surveillance are essential to containing costs for screening as well as to informing the public better about what endoscopic screening can and cannot accomplish.
随着结直肠癌筛查逐渐被公众接受，结肠镜检查的使用将会增加。腺瘤被发现后监测检查的频率是结直肠癌筛查成本的最大影响因素之一。具有里程碑意义的国家息肉研究发表十年后，何时进行监测检查以及多久会出现进展期病变这一问题仍然十分突出。目前各专业组织的监测指南各不相同。进展期腺瘤患者发生复发性进展期腺瘤的风险增加。多个非进展期腺瘤或单个非进展期腺瘤对后续进展期腺瘤或癌症风险的影响尚不清楚。对于初次检查（无论是结肠镜检查还是乙状结肠镜检查）结果为阴性后的再次检查结果，我们了解得更少。阴性检查后的检出率是确定推荐的结肠镜筛查间隔时的一个重要考虑因素。例如，支持结肠镜筛查间隔为10年的数据只是间接的。我们对阴性检查后检出率的了解极少，且这些了解来自特定的、不具代表性的人群。令人担忧的是，几项息肉预防试验的证据表明，尽管随访中监测程序的使用频率相对较高，但后续癌症的检出率高于预期。需要进一步开展基于人群的监测检查使用频率和检出率的研究。研究后续监测的必要性和所需时机对于控制筛查成本以及让公众更好地了解内镜筛查能做到什么和做不到什么至关重要。
