Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
J Korean Med Sci. 2013 Sep;28(9):1345-50. doi: 10.3346/jkms.2013.28.9.1345. Epub 2013 Aug 28.
Evaluating predictive factors for high-risk adenomas at the third colonoscopy based on two prior colonoscopies may help evaluate high-risk adenoma at the third colonoscopy. We analyzed clinical data of 131 patients at Severance Hospital from January 1997 to January 2011. All of them underwent two subsequent colonoscopies after removal of adenomas during an initial colonoscopy. Among 20 patients with high-risk adenoma at the first and second colonoscopies, 10 (50%) patients had high-risk adenoma at the third colonoscopy. Among the 67 patients who had high-risk adenoma only once at the first or second colonoscopy, 15 (22.4%) patients had high-risk adenoma at the third colonoscopy but among the 44 patients without high-risk adenoma at the first and second colonoscopies, only 1 (2.3%) patient had high-risk adenoma at the third colonoscopy (P < 0.001). A multivariate time dependent covariate Cox regression analysis confirmed that high-risk adenoma at the first and/or second colonoscopy (HR, 9.56; 95% CI, 2.37-38.54; P = 0.002) was independent predictor of high-risk adenoma at the third colonoscopy. Given these findings, data from two prior colonoscopies, not one prior examination, may help identify high-risk populations at the third colonoscopy who require careful colonoscopic surveillance.
基于前两次结肠镜检查评估第三次结肠镜检查中高危腺瘤的预测因素，可能有助于评估第三次结肠镜检查中的高危腺瘤。我们分析了 1997 年 1 月至 2011 年 1 月在首尔峨山医院的 131 例患者的临床资料。所有患者在首次结肠镜检查中切除腺瘤后均接受了随后的两次结肠镜检查。在首次和第二次结肠镜检查中均有高危腺瘤的 20 例患者中，有 10 例（50%）在第三次结肠镜检查中发现高危腺瘤。在首次或第二次结肠镜检查中仅一次发现高危腺瘤的 67 例患者中，有 15 例（22.4%）在第三次结肠镜检查中发现高危腺瘤，但在首次和第二次结肠镜检查中均无高危腺瘤的 44 例患者中，仅有 1 例（2.3%）患者在第三次结肠镜检查中发现高危腺瘤（P < 0.001）。多变量时间依赖协变量 Cox 回归分析证实，首次和/或第二次结肠镜检查中的高危腺瘤（HR，9.56；95%CI，2.37-38.54；P = 0.002）是第三次结肠镜检查中高危腺瘤的独立预测因素。基于这些发现，两次而不是一次结肠镜检查的数据可能有助于识别需要仔细结肠镜监测的第三次结肠镜检查中的高危人群。
