Institute of Medical Informatics, Biometry, and Epidemiology, Munich, Germany.
Digestion. 2013;87(3):170-5. doi: 10.1159/000348653. Epub 2013 Apr 27.
BACKGROUND/AIMS: Surveillance colonoscopy is recommended after polypectomy of adenoma and surgery for colorectal cancer. The purpose of this study was to assess the frequency of advanced adenoma and cancer in colonoscopies performed for surveillance compared to screening colonoscopies.
Analysis of relative frequencies of findings in colonoscopies performed for post-adenoma surveillance (post-ad), post-cancer surveillance (post-crc), screening, and follow-up of a positive fecal occult blood test (FOBT). Logistic regression was used to identify the risk for advanced adenoma (adenoma ≥10 mm, containing high-grade dysplasia, or villous histology) and cancer.
324,912 colonoscopies were included in the analysis: 81,877 post-ad, 26,896 post-crc, 178,305 screening, 37,834 positive FOBT. Advanced adenoma (cancer) was diagnosed in 8.0% (0.4%) of post-ad, 5.0% (1.0%) of post-crc, 7.4% (1.1%) of screening, and 11.7% (3.6%) of positive FOBT colonoscopies. Compared to screening, the odds ratios for finding advanced adenoma were 0.93 (95% CI 0.88-0.98) for post-ad, 0.96 (0.86-1.08) for post-crc, and 1.18 (1.09-1.28) for positive FOBT colonoscopies. The odds ratios for the diagnosis of cancer were 0.29 (0.24-0.36) for post-ad, 0.81 (0.61-1.07) for post-crc, and 2.77 (2.43-3.17) for positive FOBT.
Colonoscopy for post-ad surveillance but not colonoscopy for post-crc surveillance is associated with a lower risk of diagnosis of advanced adenoma and cancer.
背景/目的：腺瘤息肉切除和结直肠癌手术后建议进行结肠镜监测。本研究的目的是评估与筛查结肠镜相比，在腺瘤息肉切除后监测（post-ad）和结直肠癌手术后监测（post-crc）中发现高级别腺瘤和癌症的频率。
分析 post-ad、post-crc、筛查和阳性粪便潜血试验（FOBT）随访结肠镜检查中发现的相对频率。采用逻辑回归识别高级别腺瘤（腺瘤≥10mm，伴有高级别异型增生或绒毛状组织学）和癌症的风险。
共纳入 324912 例结肠镜检查：81877 例 post-ad，26896 例 post-crc，178305 例筛查，37834 例阳性 FOBT。post-ad、post-crc、筛查和阳性 FOBT 结肠镜检查中分别诊断出 8.0%（0.4%）、5.0%（1.0%）、7.4%（1.1%）和 11.7%（3.6%）的高级别腺瘤（癌症）。与筛查相比，post-ad 的高级别腺瘤检出比值比为 0.93（95%CI 0.88-0.98），post-crc 的比值比为 0.96（0.86-1.08），阳性 FOBT 的比值比为 1.18（1.09-1.28）。post-ad 的癌症诊断比值比为 0.29（0.24-0.36），post-crc 的比值比为 0.81（0.61-1.07），阳性 FOBT 的比值比为 2.77（2.43-3.17）。
post-ad 监测的结肠镜检查与 post-crc 监测的结肠镜检查相比，诊断高级别腺瘤和癌症的风险较低。
