Moores Cancer Center, University of California, San Diego, 3855 Health Sciences Drive 0901, La Jolla, CA 92093-0901, USA.
Ann Intern Med. 2012 Dec 18;157(12):856-64. doi: 10.7326/0003-4819-157-12-201212180-00005.
Guidelines from the United Kingdom and the United States on risk stratification after polypectomy differ, as do recommended surveillance intervals.
To compare risk for advanced colorectal neoplasia at 1-year colonoscopy among patients cross-classified by U.S. and U.K. surveillance guidelines.
Pooled analysis of 4 prospective studies between 1984 and 1998.
Academic and private clinics in the United States.
3226 postpolypectomy patients with 6- to 18-month follow-up colonoscopy.
Rates of advanced neoplasia (an adenoma ≥1 cm, high-grade dysplasia, >25% villous architecture, or invasive cancer) at 1 year, compared across U.S. and U.K. risk categories.
Advanced neoplasia was detected 1 year after polypectomy in 3.8% (95% CI, 2.7% to 4.9%) of lower-risk patients and 11.2% (CI, 9.8% to 12.6%) of higher-risk patients by U.S. criteria. According to U.K. criteria, 4.4% (CI, 3.3% to 5.4%) of low-risk patients, 9.9% (CI, 8.3% to 11.5%) of intermediate-risk patients, and 18.7% (CI, 14.8% to 22.5%) of high-risk patients presented with advanced neoplasia; U.K. high-risk patients comprised 12.1% of all patients. All U.S. lower-risk patients were low-risk by U.K. criteria; however, more patients were classified as low-risk, because the U.K. guidelines do not consider histologic features. Higher-risk U.S. patients were distributed across the 3 U.K. categories. Among all patients with advanced neoplasia, 26.3% were reclassified by the U.K. criteria to a higher-risk category and 7.0% to a lower-risk category, with a net 19.0% benefiting from detection 2 years earlier. Overall, substitution of U.K. for U.S. guidelines resulted in an estimated 0.03 additional colonoscopy every 5 years per patient.
Patients were enrolled 15 to 20 years ago, and quality measures for colonoscopy were unavailable. Patients lacking follow-up colonoscopy or with surveillance colonoscopy after 6 to 18 months and those with cancer or insufficient baseline adenoma characteristics were excluded (2076 of 5302).
Application of the U.K. guidelines in the United States could identify a subset of high-risk patients who may warrant a 1-year clearing colonoscopy without substantially increasing rates of colonoscopy.
European Union Public Health Programme.
英国和美国的息肉切除术后风险分层指南不同，建议的监测间隔也不同。
比较美国和英国监测指南交叉分类的患者在 1 年结肠镜检查时发生晚期结直肠腺瘤的风险。
1984 年至 1998 年期间进行的 4 项前瞻性研究的汇总分析。
美国的学术和私人诊所。
3226 例息肉切除术后 6 至 18 个月随访结肠镜检查的患者。
比较美国和英国风险类别中 1 年时高级别腺瘤（≥1cm 腺瘤、高级别异型增生、>25%绒毛状结构或浸润性癌）的发生率。
根据美国标准，3.8%（95%CI，2.7%至 4.9%）的低危患者和 11.2%（CI，9.8%至 12.6%）的高危患者在息肉切除术后 1 年发现高级别腺瘤。根据英国标准，4.4%（CI，3.3%至 5.4%）的低危患者、9.9%（CI，8.3%至 11.5%）的中危患者和 18.7%（CI，14.8%至 22.5%）的高危患者出现高级别腺瘤；英国高危患者占所有患者的 12.1%。所有美国低危患者均为英国低危标准，但更多患者被归类为低危，因为英国指南不考虑组织学特征。美国高危患者分布在 3 个英国类别中。所有患有高级别腺瘤的患者中，26.3%根据英国标准重新分类为高危类别，7.0%重新分类为低危类别，有 19.0%的患者受益于 2 年前更早的检测。总体而言，用英国指南替代美国指南，估计每位患者每 5 年多进行 0.03 次结肠镜检查。
患者于 15 至 20 年前入组，结肠镜检查质量指标不可用。排除了未接受随访结肠镜检查或在 6 至 18 个月后接受监测结肠镜检查的患者，以及患有癌症或基线腺瘤特征不足的患者（5302 例中的 2076 例）。
在英国应用指南可能会发现一组高危患者，他们可能需要在 1 年内进行清除性结肠镜检查，而不会显著增加结肠镜检查的比例。
欧盟公共卫生计划。
