Visovan Irina Ioana, Tantau Marcel, Ciobanu Lidia, Pascu Oliviu, Tantau Alina
Medical Center of Gastroenterology and Hepatology, Cluj-Napoca, Romania.
3rd Medical Clinic, University of Medicine and Pharmacy Iuliu Haţieganu;Regional Institute of Gastroenterology and Hepatology Octavian Fodor;Cluj-Napoca, Romania.
J Gastrointestin Liver Dis. 2014 Jun;23(2):147-51. doi: 10.15403/jgld.2014.1121.232.iiv1.
BACKGROUND & AIMS: A gradual shift of colorectal adenoma and carcinoma location toward the proximal colon has been recently observed both in the United States and Europe. We aimed to study the polyp and adenoma detection rate in a major endoscopy center of northwestern Romania over a 16-year period, and to characterize the distribution and the pathological features of the removed polyps according to age and sex, in order to assess the trend of proximal adenoma prevalence in our population.
We retrospectively analyzed 9,230 consecutive colonoscopies performed between 1996 and 2011 in a high-volume outpatient clinic in Cluj-Napoca, Romania. We analyzed 2,436 complete colonoscopies that detected 3,642 polyps in two time periods: 1996 to 2003 and 2004 to 2011. We compared the number, size and histopathological features of the polyps removed from the right-sided colon and the left sided-colon in the two periods.
An increasing trend of polyp detection rate in the right-sided colon was observed, from 9.36% in the first period to 12.17% in the second period (p<0.001). The prevalence of right-sided colon adenomas also presented an increased trend (OR 1.45; CI95% 1.02-2.05; p=0.03). High-grade dysplasia (HGD) was found in 8.6% of the adenomas and in 4.1% of the diminutive polyps. Advanced neoplasia was detected in 1.5% of persons younger than 50 years. Multivariate logistic regression analysis evidenced that the right-sided polyps were significantly associated with the last time period (OR 1.3; p=0.001; CI95% 1.12-1.56), male gender (OR-1.3; p=0.001; CI95% 1.1-1.5) and age above 48 years (OR 1.3; p=0.006: CI95% 1-1.6).
An increasing trend of polyp detection rate in the right-sided colon was documented, with an increasing prevalence of right-sided adenomas. The evaluation of the proximal colon is particularly important in males aged over 48. A clear-cut risk of HGD in the diminutive polyps and in the middle age subjects has been also observed.
最近在美国和欧洲均观察到结直肠腺瘤和癌的发病部位有逐渐向近端结肠转移的趋势。我们旨在研究罗马尼亚西北部一个主要内镜中心16年间息肉和腺瘤的检出率，并根据年龄和性别对切除息肉的分布及病理特征进行描述，以评估我国人群近端腺瘤患病率的趋势。
我们回顾性分析了1996年至2011年在罗马尼亚克卢日-纳波卡一家大容量门诊进行的9230例连续结肠镜检查。我们分析了2436例完整结肠镜检查，这些检查在两个时间段内发现了3642个息肉：1996年至2003年以及2004年至2011年。我们比较了两个时间段内从右侧结肠和左侧结肠切除息肉的数量、大小及组织病理学特征。
观察到右侧结肠息肉检出率呈上升趋势，从第一个时间段的9.36%升至第二个时间段的12.17%（p<0.001）。右侧结肠腺瘤的患病率也呈上升趋势（比值比1.45；95%置信区间1.02 - 2.05；p = 0.03）。在8.6%的腺瘤和4.1%的微小息肉中发现高级别上皮内瘤变（HGD）。在50岁以下人群中，1.5%检测到进展期肿瘤。多因素逻辑回归分析表明，右侧息肉与最后一个时间段显著相关（比值比1.3；p = 0.001；95%置信区间1.12 - 1.56）、男性（比值比 - 1.3；p = 0.001；95%置信区间1.1 - 1.5）以及48岁以上年龄（比值比1.3；p = 0.006：95%置信区间1 - 1.6）。
记录到右侧结肠息肉检出率呈上升趋势，右侧腺瘤患病率增加。对48岁以上男性进行近端结肠评估尤为重要。在微小息肉和中年受试者中也观察到了明确的高级别上皮内瘤变风险。
