Gastroenterology Department, Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Gastroenterology Department, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Dig Liver Dis. 2020 Apr;52(4):427-433. doi: 10.1016/j.dld.2019.12.147. Epub 2020 Feb 7.
Few reports address the appropriate colonoscopy surveillance interval for individuals <50-years-old. We compared the risk of metachronous neoplasia among young (<50 years), adult (50-74 years) and older (≥75 y) age groups.
This was a single center retrospective cohort study. Eligible subjects underwent their first colonoscopy with polypectomy between 2005 and 2014 and had at least one surveillance colonoscopy 3-5 years later. Patients (N = 495) were stratified at baseline into low-risk adenoma (LRA) and advanced adenoma groups. Study outcomes were overall and high-risk neoplasia at surveillance colonoscopy.
In the baseline LRA-group (N = 201), the 5-year risk of metachronous high-risk neoplasia was 12.5%, 15.2% and 22.5% (P = 0.426) in the young, adult and older age groups, respectively. In the baseline advanced adenoma group (N = 294), the 3-year risk of metachronous high-risk neoplasia was 13.3%, 14.8% and 25.3% (P = 0.041), respectively. In multivariate analysis, the only risk factor for metachronous high-risk neoplasia was older age (OR 1.876, CI 1.087-3.238; P = 0.024).
Considering the comparable risk of metachronous high-risk neoplasia in young and adult patients, surveillance recommendations after polypectomy should not differ. Since this risk is higher among older people, more frequent surveillance schedule can be considered for this age group but should be individualized.
很少有研究报道年龄<50 岁人群的结肠镜检查监测间隔时间。我们比较了年轻（<50 岁）、成年（50-74 岁）和老年（≥75 岁）人群的腺瘤间期肿瘤发生风险。
这是一项单中心回顾性队列研究。符合条件的患者在 2005 年至 2014 年间接受首次结肠镜检查和息肉切除术，并且在 3-5 年后至少进行一次结肠镜检查。患者（N=495）根据基线分为低危腺瘤（LRA）和高级别腺瘤组。研究终点为监测结肠镜检查时的总体和高危腺瘤。
在基线 LRA 组（N=201）中，年轻、成年和老年组的 5 年高危腺瘤间期肿瘤发生风险分别为 12.5%、15.2%和 22.5%（P=0.426）。在基线高级别腺瘤组（N=294）中，3 年高危腺瘤间期肿瘤发生风险分别为 13.3%、14.8%和 25.3%（P=0.041）。多变量分析显示，高危腺瘤间期肿瘤发生的唯一危险因素是年龄较大（OR 1.876，CI 1.087-3.238；P=0.024）。
考虑到年轻和成年患者的腺瘤间期高危肿瘤发生风险相当，息肉切除术后的监测建议不应有所不同。由于老年人的风险较高，因此可以考虑为该年龄组制定更频繁的监测方案，但应个体化。
