Tanaka Hidenori, Oka Shiro, Tanaka Shinji, Inagaki Katsuaki, Okamoto Yuki, Matsumoto Kenta, Boda Kazuki, Yamashita Ken, Sumimoto Kyoku, Ninomiya Yuki, Chayama Kazuaki
Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan.
Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan.
J Anus Rectum Colon. 2019 Jul 30;3(3):128-135. doi: 10.23922/jarc.2018-042. eCollection 2019.
Surveillance colonoscopy after endoscopic resection (ER) for adenomatous polyps reduces the incidence and mortality of colorectal cancer (CRC). However, its significance in the elderly population is uncertain. The study aimed to determine whether surveillance colonoscopy should be discontinued in the elderly population.
We enrolled 105 patients who underwent baseline colonoscopy between January 2004 and December 2009 and were subsequently followed-up over 5 years in our institution. All had diminutive colorectal polyps and were aged <80 years at baseline colonoscopy and ≥80 years at follow-up in May 2018. Patients who had undergone colectomy or who had inflammatory bowel disease, familial adenomatous polyposis, Lynch syndrome, and no diminutive polyps were excluded. The cumulative incidence of the target lesion was evaluated. Histopathological diagnoses included low-grade dysplasia (LGD), high-grade dysplasia (HGD), and carcinoma.
The target lesion was detected in 15% (16/105) of the patients. There was no invasive carcinoma; however, two HGDs were detected. There were three lesions that had increased from previously detected diminutive lesions, all of which were LGDs. There were no target lesions detected after 84 years of age, and the cumulative incidence was 0.20. The cumulative incidence was significantly higher in the group with HGD than in the group with no target lesions at baseline colonoscopy. There was no HGD after age 79 years, and the cumulative incidence was 0.019.
Surveillance colonoscopy for patients with diminutive polyps may be discontinued after age 79 years.
腺瘤性息肉内镜切除术后进行监测性结肠镜检查可降低结直肠癌（CRC）的发病率和死亡率。然而，其在老年人群中的意义尚不确定。本研究旨在确定是否应停止对老年人群进行监测性结肠镜检查。
我们纳入了2004年1月至2009年12月期间接受基线结肠镜检查的105例患者，并随后在我们机构进行了5年的随访。所有患者均患有微小结直肠息肉，基线结肠镜检查时年龄<80岁，2018年5月随访时年龄≥80岁。已接受结肠切除术或患有炎症性肠病、家族性腺瘤性息肉病、林奇综合征以及无微小息肉的患者被排除。评估目标病变的累积发病率。组织病理学诊断包括低级别异型增生（LGD）、高级别异型增生（HGD）和癌。
15%（16/105）的患者检测到目标病变。未发现浸润性癌；然而，检测到2例HGD。有3个病变是从先前检测到的微小病变发展而来，均为LGD。84岁以后未检测到目标病变，累积发病率为0.20。基线结肠镜检查时HGD组的累积发病率显著高于无目标病变组。79岁以后未发现HGD，累积发病率为0.019。
对于微小息肉患者，79岁以后可停止监测性结肠镜检查。
