Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow, UK.
Wolfson Wohl Cancer Research Centre, School of Cancer Sciences, University of Glasgow, Glasgow, UK.
BJS Open. 2023 May 5;7(3). doi: 10.1093/bjsopen/zrad034.
After colorectal polypectomy, 20-50 per cent of patients develop metachronous polyps and some have increased colorectal cancer risk. British Society of Gastroenterology (BSG) 2020 guidelines recommend surveillance colonoscopy for high-risk patients based on index pathology. The aim of this study was to evaluate metachronous lesion outcome using BSG 2020 criteria.
A retrospective, multicentred study was conducted including patients who had polypectomy during screening colonoscopy (2009-2016) followed by surveillance. Demographics, index pathology, and BSG 2020 risk criteria were compared with regard to metachronous lesion pathology (non-advanced versus advanced lesions) and timing of detection (early versus late). Advanced lesions were defined as adenomas/serrated polyps greater than or equal to 10 mm, high-grade dysplasia, serrated polyps with dysplasia, or colorectal cancer, and late lesions those detected greater than 2 years after the index procedure.
Of 3090 eligible patients, 2643 were included. Among these, retrospective BSG 2020 application would have excluded 51.5 per cent from surveillance. After a median of 36 months, the advanced polyp/colorectal cancer rate in BSG 2020 high-risk patients was 16.3 versus 13.0 per cent in low-risk patients. Older age (P = 0.008) correlated with advanced metachronous lesions. Male sex, greater than five polyps, and BSG 2020 high-risk criteria correlated with non-advanced and advanced lesions (P < 0.001). Older age (P < 0.001), villous features (P = 0.006), advanced index polyp (P = 0.020), and greater than five polyps (P < 0.001) correlated with early metachronous lesions. Male sex and BSG 2020 high-risk criteria correlated with early and late lesions (P < 0.001). On multivariable regression, increased polyp number (odds ratio (OR) 1.15 (95 per cent c.i. 1.07 to 1.25); P < 0.001) and villous features (OR 1.49 (95 per cent c.i. 1.05 to 2.10); P = 0.025) independently correlated with early advanced lesions. The rate of non-advanced and advanced metachronous polyps was higher in BSG 2020 high- versus low-risk patients (44.4 versus 35.4 per cent for non-advanced and 15.7 versus 11.8 per cent for advanced; P < 0.001), but the colorectal cancer rate was similar (0.6 versus 1.2 per cent). However, when examining only lesions detected greater than 2 years after the index colonoscopy in high- versus low-risk patients, no significant differences were observed (P = 0.140).
BSG 2020 criteria correlated with metachronous polyps, but did not differentiate advanced and non-advanced lesions and were not predictive of late lesions.
在结直肠息肉切除术后，20-50%的患者会出现多发性息肉，并且一些患者的结直肠癌风险增加。英国胃肠病学会（BSG）2020 年指南建议根据索引病理学对高危患者进行监测性结肠镜检查。本研究的目的是使用 BSG 2020 标准评估多发性病变的结果。
进行了一项回顾性、多中心研究，包括在筛查性结肠镜检查期间（2009-2016 年）进行息肉切除术并随后进行监测的患者。比较了人口统计学、索引病理学和 BSG 2020 风险标准与多发性病变病理学（非高级病变与高级病变）和检测时间（早期与晚期）之间的关系。高级病变定义为大于或等于 10mm 的腺瘤/锯齿状息肉、高级别异型增生、锯齿状息肉伴异型增生或结直肠癌，晚期病变定义为在索引手术后 2 年以上检测到的病变。
在 3090 名合格患者中，有 2643 名患者入选。在这些患者中，BSG 2020 标准的回溯应用将使 51.5%的患者无需进行监测。在中位数为 36 个月时，BSG 2020 高危患者的高级息肉/结直肠癌发生率为 16.3%，而低危患者为 13.0%。年龄较大（P=0.008）与高级别多发性病变相关。男性、大于五枚息肉和 BSG 2020 高危标准与非高级和高级病变相关（P<0.001）。年龄较大（P<0.001）、绒毛特征（P=0.006）、高级别索引息肉（P=0.020）和大于五枚息肉（P<0.001）与早期多发性病变相关。男性和 BSG 2020 高危标准与早期和晚期病变相关（P<0.001）。多变量回归分析显示，息肉数量增加（比值比（OR）1.15（95%置信区间 1.07 至 1.25）；P<0.001）和绒毛特征（OR 1.49（95%置信区间 1.05 至 2.10）；P=0.025）与早期高级病变独立相关。BSG 2020 高危患者中非高级和高级多发性息肉的发生率高于低危患者（非高级患者为 44.4%比 35.4%，高级患者为 15.7%比 11.8%；P<0.001），但结直肠癌的发生率相似（0.6%比 1.2%）。然而，在高风险患者中仅检查指数结肠镜检查后大于 2 年检测到的病变时，未观察到显著差异（P=0.140）。
BSG 2020 标准与多发性息肉相关，但不能区分高级和非高级病变，也不能预测晚期病变。
