Indianapolis Gastroenterology and Hepatology, Indianapolis, Indiana, USA.
Endoscopy. 2013 Oct;45(10):821-6. doi: 10.1055/s-0033-1344582. Epub 2013 Sep 9.
The risk of advanced colorectal neoplasia (ACN) after the first surveillance colonoscopy is not well quantified. The aim of the current study was to quantify the risk of ACN on the second surveillance colonoscopy based on previous colonoscopic findings.
This was a single-site study of patients with index adenomas who underwent two surveillance colonoscopies. ACN was defined as advanced adenoma (≥ 1 cm, villous histology, or high-grade dysplasia) or as "high-risk" findings (advanced adenoma or ≥ 3 non-advanced adenoma [NAA]).
Among 509 patients with low-risk index findings, 61 (12.0 %; 95 % confidence interval [CI], 9.3 % - 15.1 %) had high-risk findings on the first surveillance colonoscopy, 11 of whom (18.0 %; 95 %CI 9.4 % - 30.0 %) had high-risk findings on second surveillance colonoscopy compared with 39 (8.7 %; 95 %CI 6.3 % - 11.7 %) of the remaining 448 patients who had normal or low-risk findings on the first surveillance colonoscopy (relative risk [RR] = 2.07; 95 %CI 1.12 - 3.83). Among 456 patients with high-risk index findings, 91 (20.0 %; 95 %CI 16.3 % - 23.9 %) had high-risk findings on the first surveillance colonoscopy, 20 of whom (22.0 %; 95 %CI 14.0 % - 31.9 %) had high-risk findings on second surveillance colonoscopy compared with 40 (11.0 %; 95 %CI 8.0 % - 146 %) of the remaining 365 patients who had normal or low-risk findings on first surveillance colonoscopy (RR = 2.01; 95 %CI 1.04 - 3.32). Results were similar when only advanced adenomas were considered.
Patients with high-risk findings on index and first surveillance colonoscopies require close surveillance. Those with low-risk findings on index colonoscopy and normal/non-advanced findings on the first surveillance colonoscopy have low subsequent risk of ACN. These and previous data may be useful for generating recommendations for the timing of the second surveillance colonoscopy.
首次监测结肠镜检查后发生高级结直肠腺瘤（ACN）的风险尚未得到充分评估。本研究旨在根据先前结肠镜检查结果，量化第二次监测结肠镜检查中发生 ACN 的风险。
这是一项对接受两次监测结肠镜检查的索引腺瘤患者进行的单中心研究。ACN 定义为高级腺瘤（≥ 1cm，绒毛状组织学或高级别异型增生）或“高危”表现（高级腺瘤或≥3 个非高级腺瘤[NAA]）。
在 509 例低危指数发现的患者中，61 例（12.0%；95%置信区间[CI]，9.3%至 15.1%）在首次监测结肠镜检查时发现高危表现，其中 11 例（18.0%；95%CI，9.4%至 30.0%）在第二次监测结肠镜检查时发现高危表现，而在其余 448 例首次监测结肠镜检查时发现正常或低危表现的患者中，有 39 例（8.7%；95%CI，6.3%至 11.7%）（相对风险[RR] = 2.07；95%CI，1.12 至 3.83）。在 456 例高危指数发现的患者中，91 例（20.0%；95%CI，16.3%至 23.9%）在首次监测结肠镜检查时发现高危表现，其中 20 例（22.0%；95%CI，14.0%至 31.9%）在第二次监测结肠镜检查时发现高危表现，而在其余 365 例首次监测结肠镜检查时发现正常或低危表现的患者中，有 40 例（11.0%；95%CI，8.0%至 146%）（RR = 2.01；95%CI，1.04 至 3.32）。仅考虑高级腺瘤时，结果相似。
在索引和首次监测结肠镜检查中发现高危表现的患者需要密切监测。在索引结肠镜检查中发现低危表现且首次监测结肠镜检查中发现正常/非高级表现的患者，随后发生 ACN 的风险较低。这些和以前的数据可能有助于制定第二次监测结肠镜检查的时间建议。
