Gastrointestinal Center and Institute of Minimally-Invasive Endoscopic Care, Sano Hospital, Kobe, Hyogo 655-0031, Japan.
Department of Gastroenterology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Saitama 343-8555, Japan.
World J Gastroenterol. 2017 Nov 14;23(42):7609-7617. doi: 10.3748/wjg.v23.i42.7609.
To investigate the post-colonoscopy colorectal cancer (PCCRC) rate for high-definition (HD) colonoscopy compared with that for standard-definition colonoscopy reported previously.
Using medical records at Sano Hospital (SH) and Dokkyo Medical University Koshigaya Hospital (DMUKH), we retrospectively obtained data on consecutive patients diagnosed as having CRC between January 2010 and December 2015. The definition of PCCRC was diagnosis of CRC between 7 and 36 mo after initial high-definition colonoscopy that had detected no cancer, and patients were divided into a PCCRC group and a non-PCCRC group. The primary outcome was the rate of PCCRC for HD colonoscopy. The secondary outcomes were factors associated with PCCRC and possible reason for occurrence of early and advanced PCCRC.
Among 892 CRC patients, 11 were diagnosed as having PCCRC and 881 had non-PCCRC. The PCCRC rate was 1.7% (8/471) at SH and 0.7% (3/421) at DMUKH. In comparison with the non-PCCRC group, the PCCRC group had a significantly higher preponderance of smaller tumors (39 mm 19 mm, = 0.002), a shallower invasion depth (T1 rate, 25.4% 63.6%, = 0.01), a non-polypoid macroscopic appearance (39.0% 85.7%, = 0.02) and an earlier stage (59.7% 90.9%, = 0.03). Possible reasons for PCCRC were "missed or new" in 9 patients (82%), "incomplete resection" in 1 (9%), and "inadequate examination'" in 1 (9%). Among 9 "missed or new" PCCRC, the leading cause was non-polypoid shape for early PCCRC and blinded location for advanced PCCRC.
The PCCRC rate for HD colonoscopy was 0.7%-1.7%, being lower than that for standard-definition colonoscopy (1.8%-9.0%) reported previously employing the same methodology.
研究高清（HD）结肠镜检查后结直肠癌（PCCRC）的发生率与既往报道的标准清晰度结肠镜检查相比。
利用 Sano 医院（SH）和独协医科大学越谷医院（DMUKH）的病历，我们回顾性地获得了 2010 年 1 月至 2015 年 12 月期间连续诊断为 CRC 的患者的数据。PCCRC 的定义为初始高清结肠镜检查后 7 至 36 个月内诊断出的 CRC，且无癌症，患者分为 PCCRC 组和非 PCCRC 组。主要结局为 HD 结肠镜检查的 PCCRC 发生率。次要结局为与 PCCRC 相关的因素以及发生早期和晚期 PCCRC 的可能原因。
在 892 例 CRC 患者中，有 11 例被诊断为 PCCRC，881 例为非 PCCRC。SH 组的 PCCRC 发生率为 1.7%（8/471），DMUKH 组为 0.7%（3/421）。与非 PCCRC 组相比，PCCRC 组的肿瘤明显更小（39mm×19mm，P=0.002），浸润深度较浅（T1 率为 25.4%63.6%，P=0.01），非息肉样宏观外观（39.0%85.7%，P=0.02）和更早的阶段（59.7%~90.9%，P=0.03）。9 例 PCCRC 的可能原因是“漏诊或新发现”，占 82%，“不完全切除”占 1 例（9%），“检查不充分”占 1 例（9%）。在 9 例“漏诊或新发现”的 PCCRC 中，早期 PCCRC 的主要原因是非息肉样形态，晚期 PCCRC 的主要原因是位置隐蔽。
与既往采用相同方法的标准清晰度结肠镜检查（1.8%9.0%）相比，HD 结肠镜检查的 PCCRC 发生率为 0.7%1.7%，较低。
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