Department of Medicine, Columbia University Medical Center, 180 Fort Washington Avenue, Suite 936, New York, NY, 10032, USA.
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
Dig Dis Sci. 2022 Jul;67(7):3239-3243. doi: 10.1007/s10620-021-07108-w. Epub 2021 Jun 22.
Guidelines for surveillance colonoscopy depend on polyp histology. When patients present to a new healthcare system and report a personal history of "colon polyps," however, information on polyp histology is frequently unavailable.
To assess adenoma prevalence in patients with a history of colonic polyps of unknown histology and to compare it to patients undergoing either screening colonoscopy or surveillance colonoscopy for known adenomatous polyps.
This cohort study evaluated colonoscopies of patients ≥ 50 years of age over a 14-year period at a single institution. The exposure of interest was colonoscopy indication, categorized into three groups: screening colonoscopy, surveillance colonoscopy for history of colonic polyp(s) of unknown histology, and surveillance colonoscopy for history of adenoma(s). The primary outcome was adenoma detection rate. Multivariable logistic regression was used to assess the association between colonoscopy indication and adenoma detection rate.
Of 31,856 colonoscopies, the adenoma prevalence was 26.1% for patients undergoing screening colonoscopy, 32.9% for patients with a history of polyps of unknown histology, and 41.9% for patients with a history of known adenomatous polyps. Relative to screening colonoscopies, there were higher odds of adenoma detection in surveillance colonoscopies for polyps of unknown histology (aOR compared to screening 1.42, 95% CI 1.30-1.55) and even higher odds among surveillance colonoscopies for a history of adenoma (aOR compared to screening 1.89, 95% CI 1.75-2.05).
The adenoma prevalence on surveillance colonoscopy for patients with polyps of unknown histology was higher than that of screening colonoscopies but lower than that of surveillance colonoscopies for patients with adenomatous polyps.
结直肠镜监测的指南取决于息肉的组织学。然而，当患者新进入医疗保健系统并报告个人有“结肠息肉”病史时，通常无法获得息肉的组织学信息。
评估具有未知组织学结肠息肉病史患者的腺瘤患病率，并将其与因已知腺瘤性息肉而行筛查性结直肠镜或监测性结直肠镜的患者进行比较。
这项队列研究在 14 年期间评估了单家医疗机构中≥50 岁患者的结肠镜检查。感兴趣的暴露因素是结肠镜检查的指征，分为三组：筛查性结肠镜检查、因未知组织学结肠息肉史而行监测性结肠镜检查、因已知腺瘤史而行监测性结肠镜检查。主要结局是腺瘤检出率。多变量逻辑回归用于评估结肠镜检查指征与腺瘤检出率之间的关联。
在 31856 例结肠镜检查中，行筛查性结肠镜检查的患者中腺瘤的患病率为 26.1%，有未知组织学息肉病史的患者为 32.9%，有已知腺瘤性息肉病史的患者为 41.9%。与筛查性结肠镜检查相比，因未知组织学息肉而行监测性结肠镜检查的腺瘤检出率更高（与筛查相比的优势比为 1.42，95%CI 为 1.30-1.55），而因已知腺瘤性息肉而行监测性结肠镜检查的腺瘤检出率更高（与筛查相比的优势比为 1.89，95%CI 为 1.75-2.05）。
因未知组织学息肉而行监测性结肠镜检查的患者的腺瘤患病率高于筛查性结肠镜检查，但低于因腺瘤性息肉而行监测性结肠镜检查的患者。
