Surveillance guidelines after removal of colorectal adenomatous polyps
Surveillance guidelines after removal of colorectal adenomatous polyps
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DOI：
10.1136/gut.51.suppl_5.v6
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发表时间：
2002-10-01
期刊：
影响因子：
24.5
通讯作者：
Saunders, BP
中科院分区：
文献类型：
--
作者：
Atkin, WS;Saunders, BP
大多数结肠癌被认为有癌前腺瘤性息肉期，因此结肠镜检查和息肉切除术为癌症预防提供了机会。一些接受过结肠镜检查并切除腺瘤的患者将来患结直肠癌（CRC）的风险增加，因此可能从结肠镜检查中获益。然而，重要的是要认识到结肠镜检查是一种侵入性和昂贵的手术，并伴有一些相关的发病率。在英国，这也是一个资源不足的手术，严重缺乏训练有素的内窥镜医师。大约三分之一的人会在60岁时患上腺瘤。大多数腺瘤无症状，无法确诊。如果引入结直肠筛查，这种情况将发生巨大变化。结肠镜监测在基线清除结肠镜检查后预防结直肠癌方面的益处很少。因此，明智地应用这种做法是很重要的，在每个案例中平衡风险和收益。根据已发表的证据，本指南建议在腺瘤切除后进行适当的监测。每次结肠镜随访的决定也应取决于患者的意愿、是否存在合并症、患者的年龄和其他危险因素的存在。
Most colon cancers are assumed to have a premalignant adenomatous polyp phase, therefore colonoscopic detection and polypectomy provides the opportunity for cancer prevention. Some patients who have undergone colonoscopy and have had adenomas removed are at increased risk of developing colorectal cancer (CRC) in the future, and therefore might benefit from colonoscopic surveillance. However, it is important to appreciate that colonoscopy is an invasive and costly procedure with some associated morbidity. It is also an under-resourced procedure in the UK, with a serious lack of fully trained endoscopists. Around one third of the population will develop an adenoma by age 60. Most adenomas are asymptomatic and remain undiagnosed. If colorectal screening is introduced this situation will change dramatically. There arc few data on the benefits of colonoscopic surveillance in preventing cotorectal cancer after a baseline clearing colonoscopy. It is therefore important that this practice is applied judiciously, balancing the risks and benefits in each individual case. Using published evidence, this guideline recommends appropriate surveillance after adenoma removal. The decision to perform each follow up colonoscopy should also depend on the patient's wishes, the presence of comorbidity, the patient's age, and the presence of other risk factors.