Chen Shuling, Sun Kaiyu, Chao Kang, Sun Yuli, Hong Liru, Weng Zijin, Cui Yi, Chen Minhu, Zhang Shenghong
Division of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, People's Republic of China.
Division of Gastroenterology and Division of Medical Ultrasonics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, People's Republic of China.
Int J Colorectal Dis. 2018 Feb;33(2):131-139. doi: 10.1007/s00384-017-2951-0. Epub 2017 Dec 27.
The purpose of this study is to estimate the detection rates of adenomas and serrated polyps and to identify proximalization and associate risk factors in patients from Southern China.
Consecutive patients undergoing colonoscopy from 2004 to 2013 in Guangzhou were included. The proportions of proximal adenomas to advanced adenomas and serrated polyps were compared and potential predictors were evaluated.
Colonoscopies (n = 62,560) were performed, and 11,427 patients were diagnosed with polyps. Detection rates for adenomas, hyperplastic polyps, and serrated adenomas were 12.0, 2.5, and 0.2 patients per 100 colonoscopies. When comparing the 1st (2004-2008) to the 2nd period (2009-2013), adenoma and serrated polyp detection in proximal and distal colon both increased significantly (proximal colon [adenoma 3.9 vs. 6.1 patients/100 colonoscopies, P < 0.001; serrated polyp 0.4 vs. 1.1 patients/100 colonoscopies, P < 0.001]; distal colon [adenoma 6.6 vs. 7.2 patients/100 colonoscopies, P = 0.003; serrated polyp 1.2 vs. 2.4 patients/100 colonoscopies, P < 0.001]). Advanced adenoma detection increased over these two periods only in proximal colon (1st vs. 2nd period: 1.5 vs. 2.4 patients/100 colonoscopies, P < 0.001), not the distal colon (P = 0.114). Multivariate analyses showed that diagnostic period was an independent predictor for adenoma proximalization (OR = 1.36, 95% CI 1.25-1.48, P < 0.001), but not for advanced adenomas (P = 0.117) or serrated polyps (P = 0.928).
Adenomas and serrated polyps were increasingly detected throughout the colon, whereas advanced adenomas were only in proximal colon. A proximal shift tendency detected by colonoscopy was observed for adenomas, but not advanced adenomas or serrated polyps, in Southern China. The screening for proximal polyps should be emphasized and colonoscopy might be a preferred initial screening tool.
本研究旨在评估中国南方患者腺瘤和锯齿状息肉的检出率，确定近端化情况并识别相关危险因素。
纳入2004年至2013年在广州接受结肠镜检查的连续患者。比较近端腺瘤与高级别腺瘤及锯齿状息肉的比例，并评估潜在预测因素。
共进行了62,560例结肠镜检查，11,427例患者被诊断为息肉。腺瘤、增生性息肉和锯齿状腺瘤的检出率分别为每100例结肠镜检查12.0例、2.5例和0.2例。比较第1阶段（2004 - 2008年）和第2阶段（2009 - 2013年），近端和远端结肠的腺瘤及锯齿状息肉检出率均显著增加（近端结肠[腺瘤：3.9例/100例结肠镜检查对6.1例/100例结肠镜检查，P < 0.001；锯齿状息肉：0.4例/100例结肠镜检查对1.1例/100例结肠镜检查，P < 0.001]；远端结肠[腺瘤：6.6例/100例结肠镜检查对7.2例/100例结肠镜检查，P = 0.003；锯齿状息肉：1.2例/100例结肠镜检查对2.4例/100例结肠镜检查，P < 0.001]）。仅近端结肠的高级别腺瘤检出率在这两个时期有所增加（第1阶段对第2阶段：1.5例/100例结肠镜检查对2.4例/100例结肠镜检查，P < 0.001），远端结肠则无变化（P = 0.114）。多因素分析显示，诊断时期是腺瘤近端化的独立预测因素（OR = 1.36，95%CI 1.25 - 1.48，P < 0.001），但不是高级别腺瘤（P = 0.117）或锯齿状息肉（P = 0.928）的独立预测因素。
整个结肠腺瘤和锯齿状息肉的检出率不断增加，而高级别腺瘤仅在近端结肠。在中国南方，结肠镜检查发现腺瘤存在近端移位趋势，但高级别腺瘤和锯齿状息肉无此趋势。应强调对近端息肉的筛查，结肠镜检查可能是首选的初始筛查工具。
