Robertson Douglas J, Burke Carol A, Welch H Gilbert, Haile Robert W, Sandler Robert S, Greenberg E Robert, Ahnen Dennis J, Bresalier Robert S, Rothstein Richard I, Cole Bernard, Mott Leila A, Baron John A
Veterans Affairs Outcomes Group, Veterans Affairs Medical Center, Section of Gastroenterology, White River Junction, Vermont 05009, USA.
Ann Intern Med. 2009 Jul 21;151(2):103-9. doi: 10.7326/0003-4819-151-2-200907210-00007.
Suggested intervals for postpolypectomy surveillance colonoscopy are currently based on the adenoma findings from the most recent examination.
To determine the risk for clinically significant adenoma recurrence on the basis of the results of 2 previous colonoscopies.
Prospective cohort study.
Academic and private centers in North America.
Participants in an adenoma chemoprevention trial in which all participants had 1 or more adenoma found on complete colonoscopy at entry. For this analysis, only participants whose qualifying adenoma was their first were included. All participants then underwent second and third study colonoscopies at roughly 3-year intervals.
Proportion of patients with high-risk findings at the third study colonoscopy--either at least 1 advanced (> or = 1 cm or advanced histology) adenoma or multiple (> or = 3) adenomas.
Fifty-eight of 564 participants (10.3%) had high-risk findings at the third study examination. If the second examination showed high-risk findings, then results from the first examination added no significant information about the probability of high-risk findings on the third examination (18.2% for high-risk findings on the first examination vs. 20.0% for low-risk findings on the first examination; P = 0.78). If the second examination showed no adenomas, then the results from the first examination added significant information about the probability of high-risk findings on the third examination (12.3% if the first examination had high-risk findings vs. 4.9% if the first examination had low-risk findings; P = 0.015).
This observational study cannot specifically examine adenoma recurrence risk at intervals suggested for patients with low-risk adenomas (for example, 5 years vs. 10 years).
Information from 2 previous examinations may help identify low-risk populations that benefit little from intense surveillance. Surveillance guidelines might be tailored in selected patients to use information from 2 previous examinations, not just the most recent one.
National Institutes of Health.
目前，息肉切除术后监测结肠镜检查的建议间隔时间是基于最近一次检查中腺瘤的发现情况。
根据前两次结肠镜检查的结果确定临床上显著腺瘤复发的风险。
前瞻性队列研究。
北美的学术和私人中心。
一项腺瘤化学预防试验的参与者，所有参与者在入组时的全结肠镜检查中发现有1个或更多腺瘤。对于本分析，仅纳入其合格腺瘤为首次发现的参与者。然后，所有参与者大致每隔3年接受第二次和第三次研究性结肠镜检查。
第三次研究性结肠镜检查时高危发现患者的比例——即至少有1个进展期（≥1 cm或高级别组织学）腺瘤或多个（≥3个）腺瘤。
564名参与者中有58名（10.3%）在第三次研究性检查时有高危发现。如果第二次检查显示有高危发现，那么第一次检查的结果对于第三次检查时出现高危发现的概率没有增加显著信息（第一次检查为高危发现时为18.2%，第一次检查为低危发现时为20.0%；P = 0.78）。如果第二次检查未发现腺瘤，那么第一次检查的结果对于第三次检查时出现高危发现的概率增加了显著信息（第一次检查有高危发现时为12.3%，第一次检查有低危发现时为4.9%；P = 0.015）。
这项观察性研究无法具体检查低危腺瘤患者建议间隔时间（例如5年与10年）的腺瘤复发风险。
前两次检查的信息可能有助于识别从强化监测中获益甚微的低危人群。在特定患者中，监测指南可能需要调整，以利用前两次检查的信息，而不仅仅是最近一次检查的信息。
美国国立卫生研究院。
