Hornung Thomas A, Bevan Roisin, Mumtaz Saqib, Hornung Benjamin R, Rutter Matthew D
Northern Region Endoscopy Group, University Hospital of North Tees, Stockton-on-Tees, UK.
Northern Region Endoscopy Group, South Tyneside NHS Foundation Trust, South Shields, Tyne and Wear, UK.
Frontline Gastroenterol. 2015 Apr;6(2):77-84. doi: 10.1136/flgastro-2014-100524. Epub 2014 Oct 20.
Patients who have had colorectal adenomas removed are at increased risk of developing colorectal cancer in the future. We sought to determine whether surveillance colonoscopy at 5 years in low-risk postpolypectomy patients is necessary and effective.
UK multicentre retrospective study. Patients diagnosed with 'low-risk' colorectal adenomas between April 2004 and April 2007 were identified and results of all subsequent lower gastrointestinal (GI) endoscopies were noted. Where no colonoscopy had been done at or after 5 years from the index investigation, patient details were cross-checked against hospital colorectal multidisciplinary team databases to ensure no colorectal cancer had been detected in the meantime.
641 patients were included. 131 patients (20.4%) had a 'per protocol' surveillance colonoscopy at 5 years. Of these, no patients were found to have colorectal cancer, 10 patients (7.6%) had advanced adenomas, 26 patients (19.8%) had non-advanced adenomas and 95 patients (72.5%) had no further adenomas. 510 patients (79.6%) did not have a surveillance colonoscopy at 5 years. Of these, 110 patients (17.2%) developed lower GI symptoms within 5 years of their index endoscopy and underwent a further lower GI endoscopy to investigate these symptoms. 3 colorectal cancers in 3 patients were found during these endoscopies and two further colorectal cancers were found at symptomatic colonoscopies at or after 5 years from index.
Patients with low-risk adenomas should be risk profiled. Those with risk factors, such as two adenomas, male sex and advanced adenomas at index procedure should be offered 5-year surveillance colonoscopy.
已切除大肠腺瘤的患者未来患结直肠癌的风险会增加。我们试图确定低风险息肉切除术后患者在5年时进行监测结肠镜检查是否必要且有效。
英国多中心回顾性研究。确定2004年4月至2007年4月期间被诊断为“低风险”大肠腺瘤的患者，并记录所有后续下消化道（GI）内镜检查的结果。如果自索引调查起5年时或之后未进行结肠镜检查，则将患者详细信息与医院结直肠多学科团队数据库进行交叉核对，以确保在此期间未检测到结直肠癌。
纳入641例患者。131例患者（20.4%）在5年时进行了“按方案”监测结肠镜检查。其中，未发现患者患有结直肠癌，10例患者（7.6%）患有高级别腺瘤，26例患者（19.8%）患有非高级别腺瘤，95例患者（72.5%）未发现进一步的腺瘤。510例患者（79.6%）在5年时未进行监测结肠镜检查。其中，110例患者（17.2%）在索引内镜检查后5年内出现下消化道症状，并接受了进一步的下消化道内镜检查以调查这些症状。在这些内镜检查中发现3例患者患有3例结直肠癌，在索引后5年时或之后的症状性结肠镜检查中又发现2例结直肠癌。
低风险腺瘤患者应进行风险评估。有危险因素的患者，如两个腺瘤、男性以及索引手术时的高级别腺瘤，应接受5年监测结肠镜检查。
