Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, NC, USA.
Department of Medicine, Duke University, Durham, NC, USA.
Am J Gastroenterol. 2020 Aug;115(8):1275-1282. doi: 10.14309/ajg.0000000000000677.
Limited data inform the current postpolypectomy surveillance guidelines, which suggest a shortened interval to third colonoscopy after a negative second examination if high-risk adenomas (HRA) were present on the initial screening colonoscopy. Therefore, we examined the risk of HRA at third colonoscopy stratified by findings on 2 previous examinations in a prospective screening colonoscopy cohort of US veterans.
We identified participants who had 3 or more colonoscopies from CSP#380. We examined the risk of HRA on the third examination based on findings from the previous 2 examinations. Multivariate logistic regression was used to adjust for multiple covariates.
HRA were found at the third examination in 114 (12.8%) of 891 participants. Those with HRA on both previous examinations had the greatest incidence of HRA at third examination (14/56, 25.0%). Compared with those with no adenomas on both previous examinations, participants with HRA on the first examination remained at significantly increased risk for HRA at the third examination at 3 years after a negative second examination (odds ratio [OR] 3.41, 95% confidence interval [CI] 1.28-9.08), 5 years (OR 3.14, 95% CI 1.49-6.61), and 7 years (OR 2.89, 95% CI 1.08-7.74).
In a screening population, HRA on the first examination identified individuals who remained at increased risk for HRA at the third examination, even after a negative second examination. This finding supports current colorectal cancer surveillance guidelines, which suggest a shortened, 5-year time interval to third colonoscopy after a negative second examination if high-risk findings were present on the baseline examination.
目前的息肉切除后监测指南所依据的数据有限，如果在初始筛查结肠镜检查中发现高危腺瘤（HRA），则建议在第二次阴性检查后缩短第三次结肠镜检查的间隔时间。因此，我们在美国退伍军人的前瞻性筛查结肠镜检查队列中，根据前两次检查的结果，研究了第三次结肠镜检查时出现 HRA 的风险。
我们从 CSP#380 中确定了进行了 3 次或更多次结肠镜检查的参与者。我们根据前两次检查的结果，检查了第三次检查中出现 HRA 的风险。使用多变量逻辑回归来调整多种协变量。
在 891 名参与者中，有 114 名（12.8%）在第三次检查中发现了 HRA。在前两次检查中均发现 HRA 的患者，第三次检查中 HRA 的发生率最高（14/56，25.0%）。与前两次检查均无腺瘤的患者相比，在第二次检查阴性后 3 年、5 年和 7 年，首次检查中存在 HRA 的患者第三次检查中仍存在 HRA 的风险显著增加（优势比[OR]3.41，95%置信区间[CI]1.28-9.08）、5 年（OR 3.14，95% CI 1.49-6.61）和 7 年（OR 2.89，95% CI 1.08-7.74）。
在筛查人群中，首次检查中出现 HRA 可确定即使在第二次检查阴性后，仍存在发生 HRA 的风险增加的个体。这一发现支持当前的结直肠癌监测指南，即如果基线检查中存在高危发现，建议在第二次阴性检查后，将第三次结肠镜检查的时间间隔缩短至 5 年。
