Corporate Risk Management, AMSURG, Nashville, TN, USA.
J Clin Gastroenterol. 2010 Aug;44(7):e147-53. doi: 10.1097/MCG.0b013e3181cadce5.
To evaluate colonoscopies in patients aged 40 to 49 and 50 to 59 years from multiple endoscopy surgery centers serving a wide geographical area.
An observational prospective multicenter quality assurance review was conducted in 49 Ambulatory Surgery Centers in 17 states with 315 gastroenterologists. Care of patients and routine of gastroenterologists continued as standard practice with patients attending for purposes of screening, surveillance, and symptoms.
There were 1688 and 5090 consecutive qualified patients aged 40 to 49 and 50 to 59 years, respectively, receiving colonoscopies in a designated 4 week period. There was no significant difference (P=0.55) in the screening category between ages 40 to 49 (n=420) and 50 to 59 years (n=2705) in incidence of colon polyps although the older age group had more than 6 times the number of patients than the younger age group. Age group of 40 to 49-year-old males (21.5%) are at similar risk to 40 to 49-year-old females (21.1%) in development of carcinoma and adenoma polyps combined. Age group of 50 to 59-year-old males (31.3%) appear at greater risk (P<0.0001) than age 50 to 59-year-old females (18.4%) in development of carcinoma and adenoma polyps combined in the screening category. For surveillance and symptom categories significant differences (P<0.05) occurred between both age groups 40 to 49 and 50 to 59 years for males but not females in development of carcinoma and adenoma polyps combined.
The equal risk of colon polyps in screening colonoscopies for age 40 to 49 and 50 to 59 years suggest reexamination of current recommendations for 50 years as the beginning age for screening colonoscopy. Further studies are needed to examine sex differences and cost effectiveness of screening colonoscopies beginning at age 40 years and to explore these factors as well in surveillance and symptom categories.
评估来自多个内镜外科中心的 40 至 49 岁和 50 至 59 岁患者的结肠镜检查情况。
在 17 个州的 49 个门诊手术中心进行了一项观察性前瞻性多中心质量保证审查，共有 315 名胃肠病学家参与。患者的护理和胃肠病学家的常规治疗仍按照标准实践进行，患者接受结肠镜检查的目的是筛查、监测和症状治疗。
在指定的 4 周内，分别有 1688 名和 5090 名连续合格的 40 至 49 岁和 50 至 59 岁患者接受了结肠镜检查。在筛查类别中，40 至 49 岁（n=420）和 50 至 59 岁（n=2705）年龄组之间的结肠息肉发生率没有显著差异（P=0.55），尽管老年组的患者人数是年轻组的 6 倍多。40 至 49 岁男性（21.5%）发生癌和腺瘤息肉的风险与 40 至 49 岁女性（21.1%）相似。50 至 59 岁男性（31.3%）在筛查类别中发生癌和腺瘤息肉的风险（P<0.0001）明显高于 50 至 59 岁女性（18.4%）。在监测和症状类别中，40 至 49 岁和 50 至 59 岁两个年龄组的男性在癌和腺瘤息肉的发生方面存在显著差异（P<0.05），但女性没有。
40 至 49 岁和 50 至 59 岁年龄组的筛查结肠镜检查中结肠息肉的风险相等，这表明需要重新审查目前 50 岁作为筛查结肠镜检查起始年龄的建议。需要进一步研究以检查 40 岁开始筛查结肠镜检查的性别差异和成本效益，并在监测和症状类别中探讨这些因素。
