Department of Gastroenterology and Hepatology, Kumamoto University Hospital, Kumamoto, Japan.
Hattori Clinic, Kumamoto, Japan.
PLoS One. 2021 Jan 22;16(1):e0245211. doi: 10.1371/journal.pone.0245211. eCollection 2021.
Risk stratification by index colonoscopy is well established for first surveillance endoscopy, but whether the previous two colonoscopies affect the subsequent advanced neoplasias has not been established. Therefore, the subsequent risk based on the findings of the index and first surveillance colonoscopies were investigated. This retrospective, cohort study was conducted in two clinics and included participants who had undergone two or more colonoscopies after index colonoscopy. High-risk was defined as advanced adenoma (≥ 1 cm, or tubulovillous or villous histology, or high-grade dysplasia). Based on the findings of the index and first surveillance colonoscopies, patients were classified into four categories: category A (both colonoscopy findings were normal), category B (no high-risk findings both times), category C (one time high-risk finding), and category D (high-risk findings both times). The incidence of subsequent advanced neoplasia was examined in each category. A total of 13,426 subjects were included and surveyed during the study periods. The subjects in category D had the highest risk of advanced neoplasia (27.4%, n = 32/117). The subjects in category A had the lowest risk (4.0%, n = 225/5,583). The hazard ratio for advanced neoplasia of category D compared to category A was 9.90 (95% Confidence interval 6.82-14.35, P<0.001). Classification based on the findings of index and first surveillance colonoscopies more effectively stratifies the risk of subsequent advanced neoplasia, resulting in more proper allocation of colonoscopy resources after two consecutive colonoscopies.
基于索引结肠镜检查的风险分层在首次监测性结肠镜检查中已得到充分证实，但之前两次结肠镜检查是否会影响随后出现的高级别肿瘤尚未确定。因此，研究调查了基于索引和首次监测结肠镜检查结果的后续风险。这项回顾性队列研究在两个诊所进行，纳入了在索引结肠镜检查后进行了两次或以上结肠镜检查的参与者。高危定义为高级别腺瘤（≥1cm，或管状绒毛状或绒毛状组织学，或高级别异型增生）。根据索引和首次监测结肠镜检查的结果，患者被分为四类：A 类（两次结肠镜检查结果均正常）、B 类（两次均无高危发现）、C 类（一次发现高危）和 D 类（两次均发现高危）。在每个类别中检查了随后发生高级别肿瘤的发生率。共有 13426 名受试者在研究期间被纳入并进行了调查。D 类患者发生高级别肿瘤的风险最高（27.4%，n=32/117）。A 类患者的风险最低（4.0%，n=225/5583）。与 A 类相比，D 类发生高级别肿瘤的风险比为 9.90（95%置信区间为 6.82-14.35，P<0.001）。基于索引和首次监测结肠镜检查结果的分类更有效地分层了随后发生高级别肿瘤的风险，从而在连续两次结肠镜检查后更合理地分配结肠镜检查资源。
