Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
Preventive Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Korean Med Sci. 2019 Mar 20;34(12):e101. doi: 10.3346/jkms.2019.34.e101. eCollection 2019 Apr 1.
Current postpolypectomy surveillance guidelines are based on studies in patients aged ≥50 years. Equal application of the guidelines in patients aged < 50 years may be unreasonable. We aimed to determine an appropriate surveillance interval after adenoma removal in patients aged < 50 years.
We studied 10,013 patients who underwent ≥ 1 adenoma removal and follow-up colonoscopy. The cumulative risk of metachronous advanced colorectal neoplasia (ACRN) was compared among the eight groups based on age (30-39, 40-44, 45-49 and ≥ 50 years) and baseline adenoma characteristics (low- [LRA] and high-risk adenoma [HRA]).
The risk of metachronous ACRN in patients aged 30-39 and 40-44 years with HRA was comparable to that in those aged ≥ 50 years with LRA ( = 0.839 and = 0.381, respectively). However, the risk in those aged 45-49 years with HRA was higher than in those aged ≥ 50 years with LRA ( = 0.003), and the risk was not significantly different from that in those aged ≥ 50 years with HRA ( = 0.092). Additionally, the 5-year cumulative risk in those aged 45-49 years with LRA was not significantly different from that in those aged ≥ 50 years with LRA.
The postpolypectomy surveillance interval can be extended up to 5 years in patients aged 30-44 years with HRA, similar to those aged ≥ 50 years with LRA. However, the interval in patients aged 45-49 years with HRA and LRA should be 3 and 5 years, respectively, similar to those aged ≥ 50 years.
目前的息肉切除后监测指南基于≥50 岁患者的研究。在<50 岁的患者中同等地应用这些指南可能是不合理的。我们旨在确定<50 岁患者在腺瘤切除后的适当监测间隔。
我们研究了 10013 例接受≥1 次腺瘤切除和随访结肠镜检查的患者。根据年龄（30-39、40-44、45-49 和≥50 岁）和基线腺瘤特征（低风险腺瘤[LRA]和高风险腺瘤[HRA]），比较了 8 组患者中腺瘤复发的累积风险。
HRA 患者年龄在 30-39 岁和 40-44 岁之间的腺瘤复发风险与 LRA 患者年龄≥50 岁之间的风险相当（=0.839 和=0.381）。然而，HRA 患者年龄在 45-49 岁之间的风险高于 LRA 患者年龄≥50 岁之间的风险（=0.003），与 HRA 患者年龄≥50 岁之间的风险无显著差异（=0.092）。此外，HRA 患者年龄在 45-49 岁之间的 LRA 患者的 5 年累积风险与 LRA 患者年龄≥50 岁之间的风险无显著差异。
HRA 患者年龄在 30-44 岁之间的息肉切除后监测间隔可延长至 5 年，与 LRA 患者年龄≥50 岁相似。然而，HRA 和 LRA 患者年龄在 45-49 岁之间的间隔应为 3 年和 5 年，与 LRA 患者年龄≥50 岁相似。
