Gastroenterology Division, Kyung Hee University Hospital at Gang Dong, Kyung Hee University School of Medicine, Seoul, South Korea; Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA.
Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA.
Gastrointest Endosc. 2018 Nov;88(5):818-825.e1. doi: 10.1016/j.gie.2018.06.012. Epub 2018 Jun 13.
For young individuals (age <40 years) without strong family histories that would put them at risk for genetic colorectal cancer syndromes, it is unclear if national Multi-Society Task Force surveillance recommendations apply or if endoscopists follow these guideline recommendations when such patients are incidentally found to have adenoma(s) on colonoscopy.
We reviewed records on young (age <40 years) patients, with either no family history or only a moderate family history (1 first-degree family member with colorectal cancer at age ≥50), who were found to have neoplastic polyp(s) on their index colonoscopy. We assessed the pattern of endoscopist surveillance recommendations, whether endoscopist recommendations complied with national guidelines, and compliance with surveillance recommendations.
One hundred forty-one subjects were included, of whom 19 (13.5%) had a moderate family history of colorectal cancer. For patients with non-high-risk findings, 27.7% were asked to repeat their colonoscopy in ≤3 years and 99.0% within 5 years. Endoscopist surveillance recommendation compliance rates with national guidelines were >65.0% for low-risk neoplasia but lower for high-risk (40.0%), nonpolypoid (44.2%), and serrated neoplasia (54.2%, P < .001 for all). Subjects whose endoscopist recommendations were noncompliant with guidelines were usually recalled too early (96%). Only 24.7% of subjects were actually compliant with endoscopist surveillance recommendations.
For young patients with neoplastic polyp(s) but no strong family history, most endoscopists complied with national guidelines and recommended repeat colonoscopy in 3 to 5 years. However, relatively few patients were compliant with repeat colonoscopy recommendations. For most cases that were noncompliant with guidelines, patients were recalled too early as opposed to too late.
对于没有明显家族史、患遗传性结直肠癌综合征风险较低的年轻个体（年龄<40 岁），目前尚不清楚国家多学会工作组的监测建议是否适用，或者内镜医生在偶然发现这些患者结肠镜检查存在腺瘤时是否遵循这些指南建议。
我们回顾了年龄<40 岁、无家族史或仅有中度家族史（一级亲属中≥50 岁时患有结直肠癌）的年轻患者的记录，这些患者在其首次结肠镜检查中发现有肿瘤性息肉。我们评估了内镜医生监测建议的模式、内镜医生建议是否符合国家指南以及对监测建议的遵循情况。
共纳入 141 例患者，其中 19 例（13.5%）有中度结直肠癌家族史。对于非高危发现的患者，27.7%被要求在≤3 年内重复结肠镜检查，99.0%在 5 年内重复检查。对于低危肿瘤，内镜医生建议符合国家指南的比例>65.0%，但高危（40.0%）、非息肉样（44.2%）和锯齿状肿瘤（54.2%）的比例较低（所有 P 值均<.001）。不符合指南建议的患者通常被过早召回（96%）。仅有 24.7%的患者实际遵循了内镜医生的监测建议。
对于有肿瘤性息肉但无明显家族史的年轻患者，大多数内镜医生遵循了国家指南，建议在 3 至 5 年内重复结肠镜检查。然而，实际上遵循重复结肠镜检查建议的患者相对较少。对于大多数不符合指南的病例，患者被过早召回，而不是太晚。
