Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Statistics and Data Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Gastrointest Endosc. 2018 Mar;87(3):809-817.e1. doi: 10.1016/j.gie.2017.09.028. Epub 2017 Oct 4.
In individuals with either no or 1 to 2 nonadvanced adenomas, future risks of advanced colorectal neoplasia (AN) vary according to clinical risk factors. However, little is known about the association between the adenoma detection rate (ADR) and the risk for metachronous AN in patients with low-risk adenomas.
We identified 7171 participants with no or 1 to 2 nonadvanced adenomas at first-time screening colonoscopy. The risk of metachronous AN was investigated at surveillance colonoscopy, according to clinical characteristics and the ADR.
In multivariate analysis the risk for metachronous AN was strongly associated with increasing age, male sex, increasing number of adenomas, and the ADR of the endoscopist. With the ADR modeled as a continuous variable, each 1.0% increase in the rate of ADR predicted a 3.0% decrease in the risk of metachronous AN (adjusted odds ratio [OR], .97; 95% confidence interval [CI], .95-.99). With the ADR modeled using a binary cut-off (32%), the risk of metachronous AN was reduced in patients of endoscopists with an ADR ≥32% (adjusted OR, .53; 95% CI, .35-.83). Moreover, the risk of metachronous AN was reduced (adjusted OR, .66; 95% CI, .46-.95) in patients of endoscopists with an ADR in the highest tertile, compared with patients of endoscopists with ADRs in the lowest tertile. The impact of ADR on metachronous AN was significant for patients with low-risk adenomas rather than patients with no adenoma.
In patients with low-risk adenomas, the ADR of the endoscopist was inversely associated with the risk of metachronous AN.
在首次筛查性结肠镜检查中无或仅有 1-2 枚非进展性腺瘤的个体中，进展性结直肠肿瘤（AN）的未来风险取决于临床危险因素。然而，对于低危腺瘤患者，腺瘤检出率（ADR）与异时性 AN 风险之间的关联知之甚少。
我们在首次筛查性结肠镜检查中确定了 7171 例无或仅有 1-2 枚非进展性腺瘤的患者。根据临床特征和 ADR ，在随访性结肠镜检查中研究异时性 AN 的风险。
在多变量分析中，异时性 AN 的风险与年龄增长、男性、腺瘤数量增加和内镜医师的 ADR 强烈相关。当 ADR 作为连续变量建模时，ADR 率每增加 1.0%，异时性 AN 的风险就会降低 3.0%（调整后的比值比[OR]，0.97；95%置信区间[CI]，0.95-0.99）。当使用二分类截断值（32%）对 ADR 进行建模时，ADR≥32%的内镜医师的患者中，异时性 AN 的风险降低（调整后的 OR，0.53；95%CI，0.35-0.83）。此外，与 ADR 最低三分位的患者相比，ADR 最高三分位的内镜医师的患者异时性 AN 的风险降低（调整后的 OR，0.66；95%CI，0.46-0.95）。ADR 对异时性 AN 的影响在低危腺瘤患者中显著，而在无腺瘤患者中不显著。
在低危腺瘤患者中，内镜医师的 ADR 与异时性 AN 的风险呈负相关。
