Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA. Center for Innovation, Health Services Research and Development, The Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA. Regenstrief Institute, Inc, Indianapolis, IN, USA.
Am J Gastroenterol. 2018 Dec;113(12):1760-1762. doi: 10.1038/s41395-018-0397-9. Epub 2018 Oct 23.
Quality metrics and technological advances for colonoscopy are contributing to detection of more diminutive and small adenomas, increasing the proportion of persons undergoing surveillance for non-advanced neoplasia. In this issue, Kim and colleagues report surveillance colonoscopy findings in average-risk Koreans who had one or more adenomas on a first screening colonoscopy and found a similar risk of metachronous advanced neoplasia between those with 1-2 non-advanced adenoma (the "low-risk adenoma" group) and those with 3 or more small adenomas. The validity, generalizability, and clinical implications of the findings are considered along with recent similar studies. In sum, these studies support expanding the low-risk subgroup to include up to four diminutive tubular adenomas and perhaps persons with up to four small tubular adenomas. They also prompt consideration of "precision surveillance" that considers features of not just the polyps, but of the patient and endoscopist.
结肠镜检查的质量指标和技术进步有助于检测更小和更小的腺瘤，增加了接受非进展性肿瘤监测的人群比例。在本期中，Kim 及其同事报告了在首次筛查结肠镜检查中发现一个或多个腺瘤的韩国普通风险人群的监测结肠镜检查结果，发现具有 1-2 个非进展性腺瘤（“低危腺瘤”组）和具有 3 个或更多小腺瘤的人群之间存在相似的异时性高级别肿瘤风险。考虑到最近的类似研究，对这些发现的有效性、可推广性和临床意义进行了考虑。总之，这些研究支持将低危亚组扩大到包括多达四个微小管状腺瘤，甚至可能包括多达四个小的管状腺瘤的患者。它们还促使人们考虑“精准监测”，不仅考虑息肉的特征，还考虑患者和内镜医生的特征。
