Department of Medicine, Dartmouth-Hitchcock Medical Cancer, Lebanon, New Hampshire.
The Dartmouth Institute at Geisel School of Medicine, Lebanon, New Hampshire.
JAMA Intern Med. 2023 May 1;183(5):426-434. doi: 10.1001/jamainternmed.2023.0078.
Surveillance after prior colon polyps is the most frequent indication for colonoscopy in older adults. However, to our knowledge, the current use of surveillance colonoscopy, clinical outcomes, and follow-up recommendations in association with life expectancy, factoring in both age and comorbidities, have not been studied.
To evaluate the association of estimated life expectancy with surveillance colonoscopy findings and follow-up recommendations among older adults.
DESIGN, SETTING, AND PARTICIPANTS: This registry-based cohort study used data from the New Hampshire Colonoscopy Registry (NHCR) linked with Medicare claims data and included adults in the NHCR who were older than 65 years, underwent colonoscopy for surveillance after prior polyps between April 1, 2009, and December 31, 2018, and had full Medicare Parts A and B coverage and no Medicare managed care plan enrollment in the year prior to colonoscopy. Data were analyzed from December 2019 to March 2021.
Life expectancy (<5 years, 5 to <10 years, or ≥10 years), estimated using a validated prediction model.
The main outcomes were clinical findings of colon polyps or colorectal cancer (CRC) and recommendations for future colonoscopy.
Among 9831 adults included in the study, the mean (SD) age was 73.2 (5.0) years and 5285 (53.8%) were male. A total of 5649 patients (57.5%) had an estimated life expectancy of 10 or more years, 3443 (35.0%) of 5 to less than 10 years, and 739 (7.5%) of less than 5 years. Overall, 791 patients (8.0%) had advanced polyps (768 [7.8%]) or CRC (23 [0.2%]). Among the 5281 patients with available recommendations (53.7%), 4588 (86.9%) were recommended to return for future colonoscopy. Those with longer life expectancy or more advanced clinical findings were more likely to be told to return. For example, among patients with no polyps or only small hyperplastic polyps, 132 of 227 (58.1%) with life expectancy of less than 5 years were told to return for future surveillance colonoscopy vs 940 of 1257 (74.8%) with life expectancy of 5 to less than 10 years and 2163 of 2272 (95.2%) with life expectancy of 10 years or more (P < .001).
In this cohort study, the likelihood of finding advanced polyps and CRC on surveillance colonoscopy was low regardless of life expectancy. Despite this observation, 58.1% of older adults with less than 5 years' life expectancy were recommended to return for future surveillance colonoscopy. These data may help refine decision-making about pursuing or stopping surveillance colonoscopy in older adults with a history of polyps.
在老年人中，既往结肠息肉的监测是结肠镜检查最常见的指征。然而，据我们所知，目前尚未研究与预期寿命相关的监测结肠镜检查的使用情况、临床结果和随访建议，同时考虑了年龄和合并症。
评估预期寿命与老年人中既往息肉后监测结肠镜检查结果和随访建议的相关性。
设计、地点和参与者：这项基于登记的队列研究使用了新罕布什尔州结肠镜检查登记处（NHCR）的数据，并与医疗保险索赔数据相关联，纳入了 NHCR 中年龄在 65 岁以上、在 2009 年 4 月 1 日至 2018 年 12 月 31 日期间因既往息肉进行监测结肠镜检查且在结肠镜检查前一年有完整的医疗保险 A 部分和 B 部分覆盖且无医疗保险管理式医疗计划参与的成年人。数据于 2019 年 12 月至 2021 年 3 月进行分析。
预期寿命（<5 年、5 至<10 年或≥10 年），使用经过验证的预测模型进行估计。
主要结局是结肠息肉或结直肠癌（CRC）的临床发现和未来结肠镜检查的建议。
在纳入的 9831 名成年人中，平均（标准差）年龄为 73.2（5.0）岁，5285 名（53.8%）为男性。共有 5649 名患者（57.5%）的预期寿命为 10 年或更长，3443 名（35.0%）为 5 年至不到 10 年，739 名（7.5%）为不到 5 年。总体而言，791 名患者（8.0%）有进展性息肉（768 [7.8%]）或 CRC（23 [0.2%]）。在 5281 名有可用建议的患者中（53.7%），4588 名（86.9%）被建议进行未来的结肠镜检查。预期寿命更长或临床发现更严重的患者更有可能被建议进行结肠镜检查。例如，在没有息肉或只有小的增生性息肉的 227 名患者中，预期寿命<5 年的 132 名（58.1%）被建议进行未来的监测结肠镜检查，而预期寿命为 5 至<10 年的 1257 名患者中有 940 名（74.8%），预期寿命为 10 年或更长的 2272 名患者中有 2163 名（95.2%）（P<0.001）。
在这项队列研究中，无论预期寿命如何，监测结肠镜检查中发现进展性息肉和 CRC 的可能性都很低。尽管如此，58.1%预期寿命<5 年的老年人被建议进行未来的监测结肠镜检查。这些数据可能有助于在有息肉病史的老年人中，对是否进行或停止监测结肠镜检查做出更明智的决策。
