Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, People's Republic of China.
J Gastroenterol. 2010 Aug;45(8):838-45. doi: 10.1007/s00535-010-0227-3. Epub 2010 Mar 25.
Repeat colonoscopy is often performed within a short time after polypectomy due to the fear that colorectal adenomas were missed during the initial colonoscopy or that new adenomas have developed. The aim of this study was to estimate the actual recurrence rate of adenoma and its association with the length of the surveillance interval after polypectomy in a southern Chinese population.
A total of 1,356 patients undergoing endoscopic polypectomy and completing three or more surveillence colonoscopies between 1976 and 2007 were retrospectively analyzed. The recurrence rates of adenoma and advanced adenoma and surveillance intervals after polypectomy were identified based on the features of adenomas detected on initial colonoscopy.
The recurrence rates of advanced adenoma in patients with non-advanced adenoma on the initial colonoscopy were 0.9, 3.9, 5.8, and 29.2% during surveillance intervals of 1-3, 3-5, 5-10, and 10-20 years post-initial colonoscopy; for patients with advanced adenoma on the initial colonoscopy, the recurrence rates were 3.8, 13.1, 34.7, and 52.0% during the same surveillance intervals, respectively. Older age (p < 0.05 for trend) and male sex [hazard ratio (HR) 2.11, 95% confidence interval (CI) 1.27-3.53] were significantly associated with recurrence for advanced adenoma, as were the size and number of baseline adenoma (p < 0.05 for trend), tubulovillous, villous adenoma (HR 2.57, 95% CI 1.24-5.32), and high-grade dysplasia (HR 1.61, 95% CI 1.07-2.42). When 5% of patients had recurring advanced adenoma, the surveillance interval was estimated to be 6.9 (95% CI 6.3-12.2) years in the low-risk group and 3.0 (95% CI 2.7-3.2) years in the high-risk group.
Among our patient group, the recurrence of advanced adenoma after polypectomy increased with the length of the surveillance interval. Based on our results, a 3-year follow-up of patients after polypectomy could be effective in preventing the recurrence of advanced adenoma in high-risk patients.
由于担心在初次结肠镜检查中遗漏结直肠腺瘤或新的腺瘤已经发生，息肉切除术后经常在短时间内进行重复结肠镜检查。本研究的目的是估计腺瘤的实际复发率及其与息肉切除术后监测间隔时间的关系，该研究人群为中国南方人群。
回顾性分析了 1976 年至 2007 年间共 1356 例接受内镜息肉切除术并完成三次或更多次监测结肠镜检查的患者。根据初次结肠镜检查中发现的腺瘤特征，确定腺瘤和高级别腺瘤的复发率以及息肉切除术后的监测间隔时间。
在初次结肠镜检查中无高级别腺瘤的患者中，在初次结肠镜检查后 1-3、3-5、5-10 和 10-20 年的监测间隔内，高级别腺瘤的复发率分别为 0.9%、3.9%、5.8%和 29.2%；在初次结肠镜检查中有高级别腺瘤的患者中，相应的复发率分别为 3.8%、13.1%、34.7%和 52.0%。年龄较大（趋势检验 p<0.05）和男性（HR 2.11，95%CI 1.27-3.53）与高级别腺瘤的复发显著相关，基线腺瘤的大小和数量（趋势检验 p<0.05）、管状绒毛状、绒毛状腺瘤（HR 2.57，95%CI 1.24-5.32）和高级别异型增生（HR 1.61，95%CI 1.07-2.42）也与高级别腺瘤的复发显著相关。当 5%的患者出现高级别腺瘤复发时，低危组的监测间隔估计为 6.9（95%CI 6.3-12.2）年，高危组为 3.0（95%CI 2.7-3.2）年。
在我们的患者群体中，息肉切除术后高级别腺瘤的复发率随监测间隔时间的延长而增加。根据我们的结果，在高危患者中，息肉切除术后 3 年的随访可能有助于预防高级别腺瘤的复发。
