Digestive Endoscopy Unit, Clinique Paris-Bercy, Charenton-le-Pont 94220, France.
Digestive Endoscopy Unit, Institut Gustave Roussy, Villejuif 94800, France.
World J Gastroenterol. 2019 Jan 28;25(4):447-456. doi: 10.3748/wjg.v25.i4.447.
Colonoscopy is considered a valid primary screening tool for colorectal cancer (CRC). The decreasing risk of CRC observed in patients undergoing colonoscopy is correlated with the adenoma detection rate (ADR). Due to the fact that screening programs usually start from the age of 50, very few data are available on the risk of adenoma between 40 and 49 years. However, the incidence of CRC is increasing in young populations and it is not uncommon in routine practice to detect adenomas or even advanced neoplasia during colonoscopy in patients under 50 years.
To compare the ADR and advanced neoplasia detection rate (ANDR) according to age in a large series of patients during routine colonoscopy.
All consecutive patients who were scheduled for colonoscopy were included. Exclusion criteria were as follows: patients scheduled for partial colonoscopy or interventional colonoscopy (for stent insertion or stenosis dilation). Colonoscopies were performed in our unit by a team of 30 gastroenterologists in 2016. We determined the ADR and ANDR in each age group in the whole population and in the population with an average risk of CRC (excluding patients with personal or family history of advanced adenoma or cancer).
6027 colonoscopies were performed in patients with a median age of 57 years (range, 15-96). The ADR and ANDR were 28.6% and 9.7%, respectively, in the whole population. When comparing patients aged 40-44 ( = 382) and 45-49 years ( = 515), a strong increase in all parameters from 45 years was observed, with the ADR rising from 9.7% in patients aged 40-44 to 21.2% between 45 and 49 ( < 0.001) and the ANDR increasing from 3.1% in patients aged 40-44 to 6.4% in those aged 45-49 years ( < 0.03). With regard to patients aged 50-54 ( = 849), a statistically significant increase in the ADR and ANDR was not observed between patients aged 45-49 and those aged 50-54 years. In the population with an average risk of CRC, the ADR and ANDR were still significantly higher in patients aged 45-49 compared with those aged 40-44 years.
This study shows a significant two-fold increase in the ADR and ANDR in patients aged 45 years and over.
结肠镜检查被认为是结直肠癌（CRC）的有效初级筛查工具。在接受结肠镜检查的患者中，CRC 风险降低与腺瘤检出率（ADR）相关。由于筛查计划通常从 50 岁开始，因此在 40 岁至 49 岁之间很少有关于腺瘤风险的数据。然而，年轻人中 CRC 的发病率正在增加，在 50 岁以下的患者中进行结肠镜检查时，发现腺瘤甚至晚期肿瘤并不罕见。
在常规结肠镜检查中，比较大量患者中按年龄分组的 ADR 和高级别瘤变检出率（ANDR）。
所有计划行结肠镜检查的连续患者均被纳入研究。排除标准如下：计划行部分结肠镜检查或介入性结肠镜检查（用于支架置入或狭窄扩张）。2016 年，由 30 名胃肠病学家组成的团队在我们科室进行了结肠镜检查。我们在整个人群和平均 CRC 风险人群（排除有高级别腺瘤或癌症个人或家族史的患者）中确定了每个年龄组的 ADR 和 ANDR。
共对 6027 例中位年龄为 57 岁（范围 15-96 岁）的患者进行了结肠镜检查。整个人群的 ADR 和 ANDR 分别为 28.6%和 9.7%。在比较 40-44 岁（n=382）和 45-49 岁（n=515）的患者时，从 45 岁开始，所有参数均呈显著增加趋势，ADR 从 40-44 岁患者的 9.7%上升至 45-49 岁患者的 21.2%（<0.001），ANDR 从 40-44 岁患者的 3.1%上升至 45-49 岁患者的 6.4%（<0.03）。对于 50-54 岁（n=849）的患者，45-49 岁与 50-54 岁患者之间未观察到 ADR 和 ANDR 有统计学显著差异。在平均 CRC 风险人群中，45-49 岁患者的 ADR 和 ANDR 仍明显高于 40-44 岁患者。
本研究显示，45 岁及以上患者的 ADR 和 ANDR 显著增加了两倍。
