Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA.
The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
Obes Surg. 2020 Feb;30(2):407-415. doi: 10.1007/s11695-019-04176-w.
Evolving epidemiological data, backed by mechanistic evidence, supports a paradoxical increase in the risk of colorectal cancer after Roux-en-Y gastric bypass surgery (RYGB). We examined the risk of colonic polyps after RYGB.
A single-center retrospective study included colonoscopies performed between the years 1994 and 2018. To focus on the long-term impact of RYGB on precancerous colonic polyps, we compared patients at average risk for CRC who underwent colonoscopy ≥ 5 years after RYGB (n = 86) versus pre-RYGB (n = 106). We analyzed our data using inverse probability of treatment weighting (IPTW) using propensity scores in order to account for multiple potential confounders.
After IPTW, we found no statistical differences between pre- and post-RYGB patients for risk of any polyp (33.2% pre- vs. 32.7% post-RYGB). However, the percentage of serrated polyps was higher ≥ 5 years post-RYGB compared with pre-RYGB (8.7% vs. 2.1%, p = 0.04, relative risk = 4.22; 95% CI 0.97, 18.4). Body mass index ≥ 30 kg/m at time of colonoscopy was associated with a greater risk for any polyp after RYGB (OR 6.23; 95% CI 1.16, 33.41). There was also a trend towards increased risk of polyps in post-RYGB patients who were current smokers (OR = 4.97; 95% CI 0.82, 30) or with age > 55 years (OR = 2.49; 95% CI 0.88, 7.00).
Our data suggest that RYGB is associated with an increased risk of serrated polyps after 5 years from surgery. Prospective studies defining this risk and examining mechanisms will be instrumental for application of CRC preventative strategies in this population.
不断变化的流行病学数据以及机制证据表明，在 Roux-en-Y 胃旁路手术后（RYGB）结直肠癌的风险呈悖论性增加。我们研究了 RYGB 后结肠息肉的风险。
一项单中心回顾性研究纳入了 1994 年至 2018 年进行的结肠镜检查。为了关注 RYGB 对癌前结肠息肉的长期影响，我们比较了平均风险结直肠癌患者在 RYGB 后 5 年以上（n=86）与 RYGB 前（n=106）的结肠镜检查。我们使用倾向评分的逆概率治疗加权（IPTW）分析我们的数据，以考虑多个潜在的混杂因素。
在 IPTW 后，我们发现 RYGB 前后患者的任何息肉风险无统计学差异（RYGB 前 33.2%，RYGB 后 32.7%）。然而，≥5 年后 RYGB 后锯齿状息肉的比例高于 RYGB 前（8.7% vs. 2.1%，p=0.04，相对风险=4.22；95%CI 0.97, 18.4）。结肠镜检查时 BMI≥30kg/m2 与 RYGB 后任何息肉的风险增加相关（OR 6.23；95%CI 1.16, 33.41）。在 RYGB 后仍吸烟（OR=4.97；95%CI 0.82, 30）或年龄>55 岁（OR=2.49；95%CI 0.88, 7.00）的患者中，息肉的风险也呈增加趋势。
我们的数据表明，RYGB 术后 5 年与锯齿状息肉的风险增加相关。前瞻性研究定义这种风险并检查机制将对该人群中结直肠癌预防策略的应用具有重要意义。
