Toydemir Toygar, Özgen Görkem, Çalıkoğlu İsmail, Ersoy Özdal, Yerdel Mehmet Ali
İstanbul Bariatrics, Obesity and Advanced Laparoscopy Center, Hakkı Yeten Cad, Yeşil Çimen sok, Polat Tower, Şişli, 34394, İstanbul, Turkey.
Department of Gastroenterology, Acıbadem Fulya Hospital, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey.
Obes Surg. 2019 Aug;29(8):2430-2435. doi: 10.1007/s11695-019-03819-2.
Obesity and metabolic syndrome (MetS) are associated with colorectal neoplasia (CRN) and carcinoma (CRC). Whether such subjects must undergo screening colonoscopy (SC) earlier, is unknown. Incidences of CRNs in 40-49- versus 50-65-year-old bariatric patients were compared by SC. No prospective data on SC is available in morbidly obese/MetS.
Surgical weight loss candidates over 39 years of age, asymptomatic, and average-risk for CRC offered SC. Those giving written informed consent were enrolled. Colonoscopies were done by the same surgeon. Smoking/drinking history, fasting blood glucose (FBG), insulin, C-peptide, triglyceride, high density lipoprotein, vitamin D, HbA1c, and insulin resistance parameters were recorded. CRN rate and the distribution of variables in patients 40-49 years of age were compared with 50-65. Student's t and Chi-square tests were used as appropriate. P < 0.05 was regarded as statistically significant.
Among 168 SCs, 47 had CRNs (27.9%). Including carcinoma, 15 had an advanced CRN (aCRN) (8.9% aCRN and 0.6% CRC). CRN rate was 35.6% in ≥ 50 years old whereas 22.1% in 40-49 (p = 0.053). aCRN rates (8.4% in 40-49 versus 9.6% in 50-65) were similar (p = 0.792). Metabolic parameters and smoking-drinking history were equally distributed between the groups except FBG and HbA1c as their mean levels were slightly higher in the 50-65 age group (p < 0.05).
Presented results warrant routine SC in the 40-49-year-old morbidly obese and/or MetS patient population with average risk, and in aged > 50, it certainly must be enforced and included in the preoperative check-list if not done before.
肥胖和代谢综合征（MetS）与结直肠肿瘤（CRN）及癌（CRC）相关。这类患者是否必须更早接受筛查结肠镜检查（SC）尚不清楚。通过SC比较了40 - 49岁与50 - 65岁肥胖症患者的CRN发生率。病态肥胖/MetS患者中尚无关于SC的前瞻性数据。
对39岁以上、无症状且患CRC平均风险的手术减肥候选者提供SC。获得书面知情同意者纳入研究。结肠镜检查由同一位外科医生进行。记录吸烟/饮酒史、空腹血糖（FBG）、胰岛素、C肽、甘油三酯、高密度脂蛋白、维生素D、糖化血红蛋白（HbA1c）及胰岛素抵抗参数。比较40 - 49岁与50 - 65岁患者的CRN发生率及变量分布。适当使用学生t检验和卡方检验。P < 0.05被视为具有统计学意义。
在168例SC检查中，47例有CRN（27.9%）。包括癌在内，15例有进展期CRN（aCRN）（aCRN为8.9%，CRC为0.6%）。≥50岁患者的CRN发生率为35.6%，而40 - 49岁患者为22.1%（p = 0.053）。aCRN发生率（40 - 49岁为8.4%，50 - 65岁为9.6%）相似（p = 0.792）。除FBG和HbA1c外，两组间代谢参数及吸烟饮酒史分布相同，因为50 - 65岁年龄组的平均水平略高（p < 0.05）。
目前的结果表明，对于40 - 49岁平均风险的病态肥胖和/或MetS患者群体应进行常规SC检查，对于50岁以上患者，如果术前未进行，肯定必须进行并列入术前检查清单。
