Almadi Majid A, Alharbi Othman, Azzam Nahla, Wadera Junaid, Sadaf Nazia, Aljebreen Abdulrahman M
Department of Medicine, Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia; Division of Gastroenterology, The McGill University Health Center, Montreal General Hospital, McGill University, Montreal, Canada, .
Saudi J Gastroenterol. 2014 May-Jun;20(3):154-61. doi: 10.4103/1319-3767.132986.
BACKGROUND/AIMS: Colorectal cancer (CRC) is the second most common malignancy in the Saudi population, with an increasing incidence over the past 20 years. We aim to determine the baseline polyp as well as adenoma prevalence in a large cohort of patients and to find the possible age in which, if deemed appropriate, a CRC screening program should be initiated.
A retrospective cohort study was conducted using an endoscopic reporting database of individuals seen at a major tertiary care university hospital (King Khalid University Hospital) in Riyadh, Saudi Arabia. Consecutive Saudi patients who underwent a colonoscopy between August 2007 and April 2012 were included. Patients were excluded if the indication for the colonoscopy was colon cancer, colonic resection, active colitis, active diverticulitis, inflammatory bowel disease, or if the patient was referred for polypectomy.
2654 colonoscopies were included in the study. The mean age of the study population was 50.5 years [standard deviation (SD) 15.9] and females represented 57.7%. The polyp detection rate in completed colonoscopies was 20.8% (95% CI: 19.2-22.5). Adenomas were found in 8.1% (95% CI: 7.1-9.1), while advanced adenomas were found in only 0.5% (95% CI: 0.2-0.7). Adenomas were found in the left side of the colon in 33.9%, followed by the rectum in 14.6%, ascending colon and cecum in 14.2%, transverse colon in 8.7%, and in multiple locations in 28.7%. Those with a prior history of polyps or CRC were more likely to have an adenoma at colonoscopy than those who did not (14.3% vs. 6.6%; P < 0.01). The adenoma prevalence varied between age groups and ranged from 6.2% to 13.6% with a higher proportion in older individuals; this trend was seen both in males (6.0-14.5%) and females (6.4-14.6%) as well as in those who had screening colonoscopies (6.3-18.4%). No age could be found at which a CRC screening program would be appropriate to initiate.
The prevalence of polyps and adenomas in this cohort is less than that reported in the Western populations. But as this cohort included younger and symptomatic patients with only a small proportion undergoing screening, further studies in an asymptomatic population are needed.
背景/目的：结直肠癌（CRC）是沙特人群中第二常见的恶性肿瘤，在过去20年中发病率不断上升。我们旨在确定一大群患者的基线息肉以及腺瘤患病率，并找出在适当情况下应启动CRC筛查计划的可能年龄。
使用沙特阿拉伯利雅得一家大型三级护理大学医院（哈利德国王大学医院）的内镜报告数据库进行了一项回顾性队列研究。纳入了2007年8月至2012年4月期间接受结肠镜检查的连续沙特患者。如果结肠镜检查的指征是结肠癌、结肠切除术、活动性结肠炎、活动性憩室炎、炎症性肠病，或者患者因息肉切除术而被转诊，则将其排除。
该研究纳入了2654例结肠镜检查。研究人群的平均年龄为50.5岁[标准差（SD）15.9]，女性占57.7%。完整结肠镜检查中的息肉检出率为20.8%（95%CI：19.2 - 22.5）。腺瘤的检出率为8.1%（95%CI：7.1 - 9.1），而高级别腺瘤仅占0.5%（95%CI：0.2 - 0.7）。腺瘤在结肠左侧的检出率为33.9%，其次是直肠为14.6%，升结肠和盲肠为14.2%，横结肠为8.7%，多个部位为28.7%。有息肉或CRC病史的患者在结肠镜检查时比没有的患者更有可能患有腺瘤（14.3%对6.6%；P < 0.01）。腺瘤患病率在不同年龄组之间有所不同，范围从6.2%到13.6%，老年个体中比例更高；男性（6.0 - 14.5%）、女性（6.4 - 14.6%）以及接受筛查结肠镜检查的患者（6.3 - 18.4%）中均可见此趋势。未发现适合启动CRC筛查计划的年龄。
该队列中息肉和腺瘤的患病率低于西方人群报告的患病率。但由于该队列包括年轻和有症状的患者，只有一小部分接受了筛查，因此需要对无症状人群进行进一步研究。
