Shin Jae Gyu, Kim Hyung Wook, Park Su Bum, Choi Cheol Woong, Kang Dae Hwan, Kim Su Jin, Nam Hyeong Seok, Ryu Dae Gon
Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
Medicine (Baltimore). 2017 May;96(19):e6742. doi: 10.1097/MD.0000000000006742.
Missed polyps are frequently observed in surveillance colonoscopy or referral resection. We evaluated the polyp missing rate and its associated risk factors in patients who were referred to a tertiary hospital for endoscopic resection of advanced colorectal neoplasia.A total of 388 patients with advanced neoplasia who underwent colonoscopy in their referring hospitals and only endoscopic resection without total colonoscopy in Pusan National University Yangsan Hospital from 2009 to 2014 and who underwent surveillance colonoscopy within 6 to 12 months were retrospectively analyzed.The per-patient missing rate for polyps, adenomas, and advanced neoplasia in referring hospital were 58.2% (226 cases), 47.2% (183 cases), and 5.7% (22 cases), respectively. The advanced neoplasia in surveillance colonoscopy comprised the following: ≥1 cm lesions (11 cases, 50%), high-grade dysplasia (4 cases, 18.2%), villous adenoma (4 cases, 18.2%), and invasive cancer (3 cases, 13.6%). Risk factors for missed adenomas in multivariate analysis were ≥60 years (P = .004), male (P <.001), and no usage of the cap-assisted colonoscopy (P = .015). Missed polyps/adenomas were most frequent in the ascending colon (P <.001).The missing rate for polyps/adenomas of referring hospitals was higher than expected. Especially, patients with old age or male, or no usage of cap-assisted colonoscopy on initial colonoscopy were at increased risk of missed adenoma. Careful complete colonoscopy during referral resection or early surveillance colonoscopy is mandatory in the patients with advanced colorectal neoplasia and unknown-quality index colonoscopy.
在监测结肠镜检查或转诊切除术中经常会发现漏诊的息肉。我们评估了转诊至三级医院进行晚期结直肠肿瘤内镜切除的患者中息肉漏诊率及其相关危险因素。对2009年至2014年在其转诊医院接受结肠镜检查且仅在釜山国立大学杨山医院进行内镜切除而未进行全结肠镜检查、并在6至12个月内接受监测结肠镜检查的388例晚期肿瘤患者进行了回顾性分析。转诊医院中每位患者的息肉、腺瘤和晚期肿瘤的漏诊率分别为58.2%（226例）、47.2%（183例）和5.7%（22例）。监测结肠镜检查中的晚期肿瘤包括：≥1 cm病变（11例，50%）、高级别上皮内瘤变（4例，18.2%）、绒毛状腺瘤（4例，18.2%）和浸润性癌（3例，13.6%）。多因素分析中腺瘤漏诊的危险因素为≥60岁（P = 0.004）、男性（P < 0.001）以及未使用帽辅助结肠镜检查（P = 0.015）。漏诊的息肉/腺瘤在升结肠最为常见（P < 0.001）。转诊医院的息肉/腺瘤漏诊率高于预期。特别是，年龄较大或男性患者，或初次结肠镜检查时未使用帽辅助结肠镜检查的患者，腺瘤漏诊风险增加。对于晚期结直肠肿瘤且初次结肠镜检查质量指标未知的患者，在转诊切除术中仔细进行全结肠镜检查或早期进行监测结肠镜检查是必要的。
