Singhal Shashideep, Changela Kinesh, Basi Puneet, Mathur Siddharth, Reddy Sridhar, Momeni Mojdeh, Krishnaiah Mahesh, Anand Sury
Division of Gastroenterology, Department of Internal Medicine, The Brooklyn Hospital Center, Brooklyn, NY 11205, USA ; Digestive and Liver Diseases, Columbia University Medical Center, 5141 Broadway, New York, NY 10034, USA.
Division of Gastroenterology, Department of Internal Medicine, The Brooklyn Hospital Center, Brooklyn, NY 11205, USA.
ISRN Gastroenterol. 2014 Apr 6;2014:179291. doi: 10.1155/2014/179291. eCollection 2014.
Background. Utilization of colonoscopy for routine colorectal cancer (CRC) screening in the elderly (patients over 75) is controversial. This study was designed to evaluate if using fecal occult blood test (FOBT) to select patients for colonoscopy can improve yield and be a cost- effective approach for the elderly. Methods. Records of 10,908 subjects who had colonoscopy during the study period were reviewed. 1496 (13.7%) were ≥75 years. In 118 of these subjects, a colonoscopy was performed to evaluate a positive FOBT. Outcomes were compared between +FOBT group (F-Group) and the asymptomatic screening group (AS-Group). The cost-effectiveness was also calculated using a median estimated standardized worldwide colonoscopy and FOBT cost (rounded to closest whole numbers) of 1000 US $ and 10 US $, respectively. Results. 118/1496 (7.9%) colonoscopies were performed for evaluation of +FOBT. 464/1496 (31%) colonoscopies were performed in AS-Group. In F-Group, high risk adenoma detection rate (HR-ADR) was 15.2%, and 11.9% had 1-2 tubular adenomas. In comparison, the control AS-Group had HR-ADR of 19.2% and 17.7% had 1-2 tubular adenomas. In the FOBT+ group, CRC was detected in 5.1% which was significantly higher than the AS-Group in which CRC was detected in 1.7% (P = 0.03). On cost-effectiveness analysis, cost per CRC detected was significantly lower, that is, 19,666 US $ in F-Group in comparison to AS-Group 58,000 US $ (P < 0.05). There were no significant differences in other parameters among groups. Conclusion. Prescreening with FOBT to select elderly for colonoscopy seems to improve the yield and can be a cost-effective CRC screening approach in this subset. The benefit in the risk benefit analysis of screening the elderly appears improved by prescreening with an inexpensive tool.
背景。在老年人（75岁以上患者）中使用结肠镜检查进行常规结直肠癌（CRC）筛查存在争议。本研究旨在评估使用粪便潜血试验（FOBT）选择患者进行结肠镜检查是否能提高检出率，以及对老年人来说是否是一种具有成本效益的方法。方法。回顾了研究期间接受结肠镜检查的10908名受试者的记录。其中1496名（13.7%）年龄≥75岁。在这些受试者中，有118名因FOBT阳性而接受了结肠镜检查。对FOBT阳性组（F组）和无症状筛查组（AS组）的结果进行了比较。还使用估计的全球结肠镜检查和FOBT成本中位数（四舍五入到最接近的整数）分别为1000美元和10美元来计算成本效益。结果。118/1496（7.9%）的结肠镜检查是为了评估FOBT阳性而进行的。464/1496（31%）的结肠镜检查在AS组中进行。在F组中，高危腺瘤检出率（HR-ADR）为15.2%，11.9%有1-2个管状腺瘤。相比之下，对照AS组的HR-ADR为19.2%，17.7%有1-2个管状腺瘤。在FOBT阳性组中，CRC检出率为5.1%，显著高于AS组的1.7%（P = 0.03）。在成本效益分析中，F组每例CRC检出的成本显著更低，即19666美元，而AS组为58000美元（P < 0.05）。各组间其他参数无显著差异。结论。用FOBT进行预筛查以选择老年人进行结肠镜检查似乎能提高检出率，并且对这一亚组人群来说可能是一种具有成本效益的CRC筛查方法。通过使用廉价工具进行预筛查，对老年人进行筛查的风险效益分析中的益处似乎有所提高。
