Rostirolla Renata Andreoli, Pereira-Lima Júlio Carlos, Teixeira Cláudio Rolim, Schuch Aline Weyne, Perazzoli Camila, Saul Carlos
Santa Casa de Porto Alegre.
Arq Gastroenterol. 2009 Jul-Sep;46(3):167-72. doi: 10.1590/s0004-28032009000300005.
Colonoscopy with polypectomy reduces the incidence of colorectal cancer and its associated mortality. The ideal interval between surveillance examinations is determined by clinical features and endoscopic findings considered as risk factors to the development of advanced colonic neoplasias.
To determine the development rate of advanced neoplasia in patients submitted to surveillance colonoscopy in a tertiary referral center.
Three hundred and ninety two patients who underwent two or more complete colonoscopies between 1995 and 2005, and who have at least one diagnosed colorectal adenoma entered into the study. The endoscopic findings of the first and subsequent colonoscopies of each patient were analysed, considering advanced neoplasia as the main outcome. The patients enrolled were divided in accordance to the first colonoscopy findings in groups 1 or high risk; 2 or low risk; and 3 or without adenoma at the first colonoscopy. The development of advanced colorectal neoplasia and the period of surveillance until the outcome were analysed and compared among groups.
Twenty eight per cent of patients had advanced adenomas at index colonoscopy; 57.8% presented with low grade dysplasia neoplastic lesions and 14.1% had no adenoma at the first examination. The mean age was 59.54 +/- 11.74 years. Twenty six point four per cent of subjects from group 1 presented with advanced neoplasia during the surveillance period, while this outcome occurred in 10.9% and 5.3% of patients from groups 2 and 3, respectively (P<0,05). The mean period of surveillance was 123.35 months, and the mean time between the first examination and the one which presented with the outcome statistically differed among group 1 and the others, being 104.02, 115.31 and 120.61 months, respectively.
Patients with advanced neoplasia at index colonoscopy presented with a higher probability of harbouring this condition during the follow-up when compared with other two groups. These lesions also occur earlier in this patients than in the ones without these lesions at the first examination.
结肠镜下息肉切除术可降低结直肠癌的发病率及其相关死亡率。监测检查之间的理想间隔由临床特征和被视为晚期结肠肿瘤发生风险因素的内镜检查结果决定。
确定在三级转诊中心接受监测结肠镜检查的患者中晚期肿瘤的发生率。
392例在1995年至2005年间接受了两次或更多次全结肠镜检查且至少诊断出一个结直肠腺瘤的患者纳入本研究。分析每位患者首次及后续结肠镜检查的内镜检查结果，将晚期肿瘤作为主要观察指标。根据首次结肠镜检查结果，将入选患者分为1组或高风险组；2组或低风险组；3组或首次结肠镜检查时无腺瘤组。分析并比较各组晚期结直肠肿瘤的发生情况以及直至出现该结果的监测期。
28%的患者在首次结肠镜检查时有晚期腺瘤；57.8%表现为低级别发育异常肿瘤性病变，14.1%在首次检查时无腺瘤。平均年龄为59.54±11.74岁。1组中26.4%的受试者在监测期出现晚期肿瘤，而2组和3组患者的这一比例分别为10.9%和5.3%（P<0.05）。平均监测期为123.35个月，1组与其他组相比，首次检查与出现结果之间的平均时间在统计学上存在差异，分别为104.02、115.31和120.61个月。
与其他两组相比，首次结肠镜检查时有晚期肿瘤的患者在随访期间患该疾病的可能性更高。这些病变在这些患者中出现的时间也比首次检查时没有这些病变的患者更早。
