Park Soo-Kyung, Song Young Seok, Jung Yoon Suk, Kim Won Hee, Soo Eun Chang, Ko Bong Min, Seo Geom Seog, Cha Jae Myung, Park Jae Jun, Mo Moon Chang, Jung Yunho, Jeon Seong Ran, Park Dong Il
Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
J Gastroenterol Hepatol. 2017 May;32(5):1026-1031. doi: 10.1111/jgh.13643.
There is controversy about the surveillance interval after colonoscopy when 5-10 adenomas have been found on index colonoscopy. This study aimed to investigate the risk of colorectal neoplasm (CRN) according to the number of adenomas at index colonoscopy.
A retrospective, multicenter study was conducted at 10 university hospitals in Korea. We included 1394 patients with ≥ 3 adenomas at index colonoscopy. The risk of advanced CRN was compared according to the number of adenomas (intermediate risk group, 3-4 small adenomas or at least one ≥ 10 mm, and high risk group, ≥ 5 small adenomas or ≥ 3 at least one ≥ 10 mm).
Overall, 164 (11.8%) developed an advanced CRN after a mean of 4.0 years from baseline colonoscopy. The 3-year and 5-year risk of advanced CRN was 2.1% (95% CI 2.09-2.11) and 14.4% (95% CI 14.36-14.44) in intermediate risk group and 3.2% (95% CI 3.19-3.21) and 23.3% (95% CI 19.15-19.25) in high risk group (P = 0.01). Having ≥ 5 adenomas (OR = 1.57, 95% CI 1.11-2.23, P = 0.01) detected at index colonoscopy was a significant risk factor for developing advanced CRN.
Although risk of advanced CRN in patients with 5-10 adenomas was significantly higher than that in patients with 3-4 adenomas, the cumulative risk at 3 years was low at 3.2%. Thus, we suggest that a 3-year surveillance interval might be appropriate for the patients with 5-10 adenomas, and further prospective studies are needed to investigate whether more intensive surveillance is needed in this group.
初次结肠镜检查发现5至10个腺瘤时，结肠镜检查后的监测间隔存在争议。本研究旨在根据初次结肠镜检查时腺瘤的数量调查结直肠肿瘤（CRN）的风险。
在韩国的10所大学医院进行了一项回顾性多中心研究。我们纳入了初次结肠镜检查时有≥3个腺瘤的1394例患者。根据腺瘤数量（中度风险组，3至4个小腺瘤或至少1个≥10毫米，高风险组，≥5个小腺瘤或≥3个至少1个≥10毫米）比较进展期CRN的风险。
总体而言，从基线结肠镜检查开始平均4.0年后，164例（11.8%）发生了进展期CRN。中度风险组进展期CRN的3年和5年风险分别为2.1%（95%可信区间2.09 - 2.11）和14.4%（95%可信区间14.36 - 14.44），高风险组分别为3.2%（95%可信区间3.19 - 3.21）和23.3%（95%可信区间19.15 - 19.25）（P = 0.01）。初次结肠镜检查时检测到≥5个腺瘤（比值比=1.57，95%可信区间1.11 - 2.23，P = 0.01）是发生进展期CRN的显著危险因素。
虽然5至10个腺瘤患者进展期CRN的风险显著高于3至4个腺瘤患者，但3年时的累积风险较低，为3.2%。因此，我们建议对于有5至10个腺瘤的患者，3年的监测间隔可能是合适的，并且需要进一步的前瞻性研究来调查该组患者是否需要更密集的监测。
