在剩余结肠中发现盲肠腺瘤是否会增加发现更多和更高级别腺瘤的风险？

Does Finding Cecal Adenoma Increase the Risk of Discovering More and Advanced Adenomas in the Remainder of the Colon?

机构信息

From the Department of Internal Medicine and the Division of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, and the Veterans Affairs Medical Center, Oklahoma City, Oklahoma.

出版信息

South Med J. 2022 Sep;115(9):693-697. doi: 10.14423/SMJ.0000000000001444.

DOI:10.14423/SMJ.0000000000001444

PMID:36055657

Abstract

OBJECTIVES

Adenomatous polyps are common, occurring in up to 25% of the population older than 50 years of age in the United States. Conflicting data are present in the literature about the impact of specific adenoma locations and the prediction on the number and advanced histology of adenomas elsewhere. With this study we aimed to review the association between cecal adenoma and the risk of discovering more and advanced adenomas in the remainder of the colon.

METHODS

We performed a retrospective study of 1880 patients who received outpatient colonoscopies between June 2012 and December 2014 at the Veterans Affairs Medical Center in Oklahoma City. The data collected included patient demographics, indications for colonoscopy, smoking history, alcohol use, family history of colon cancer, quality of bowel preparation, number of adenomas, location, size of adenomas, and the histology of adenomas and colon cancer.

RESULTS

The mean age of the study population was 61.6 ± 9.4 year, with 95% of the population being men. Cecal adenomas were found in 243 (12.9%) of patients. Patients with cecal adenoma tended to be older (65 ± 7 vs 61 ± 10, < 0.0001), more likely to be men (97% vs 94%, = 0.06) and less likely to have a colonoscopy done for screening indication (11% vs. 13%., = 0.03). After adjusting for age, sex, indication, and quality of bowel preparation, patients with cecal adenoma were found to have a sixfold increase in finding ≥10 other adenomas elsewhere (4.5% vs 0.8% = 0.0009) and a threefold increase in finding advanced adenomas (17.7% vs 9.9% = 0.002) in the remainder of the colon. Stratifying by location, the increased risk was more pronounced in the right side (24.7% vs 8.9% ≤ 0.0001) compared with the left side.

CONCLUSIONS

Cecal adenoma is associated with an increased risk of finding more and advanced adenomas in the remainder of the colon, especially on the right side; therefore, the discovery of a cecal adenoma should prompt a more thorough evaluation of the entire colon, particularly the right colon.

摘要

目的

腺瘤性息肉在美国较为常见，50 岁以上人群中发病率高达 25%。文献中关于特定腺瘤位置及其对其他部位腺瘤数量和高级别组织学的预测作用的数据存在矛盾。本研究旨在探讨盲肠腺瘤与发现更多和更高级别结肠腺瘤之间的关系。

方法

我们对 2012 年 6 月至 2014 年 12 月在俄克拉荷马城退伍军人事务医疗中心接受门诊结肠镜检查的 1880 例患者进行了回顾性研究。收集的数据包括患者的人口统计学资料、结肠镜检查指征、吸烟史、饮酒史、结肠癌家族史、肠道准备质量、腺瘤数量、位置、大小以及腺瘤和结肠癌的组织学特征。

结果

研究人群的平均年龄为 61.6±9.4 岁，95%为男性。243 例（12.9%）患者发现盲肠腺瘤。盲肠腺瘤患者年龄较大（65±7 岁比 61±10 岁，<0.0001），更可能为男性（97%比 94%，=0.06），且更可能因非筛查指征而行结肠镜检查（11%比 13%，=0.03）。在校正年龄、性别、指征和肠道准备质量后，我们发现盲肠腺瘤患者在其余结肠发现≥10 个其他腺瘤的风险增加 6 倍（4.5%比 0.8%，=0.0009），发现高级别腺瘤的风险增加 3 倍（17.7%比 9.9%，=0.002）。按部位分层，右侧（24.7%比 8.9%，≤0.0001）的风险增加更为显著。