Case-control study supports extension of surveillance interval after colonoscopic polypectomy to at least 5 yr
Case-control study supports extension of surveillance interval after colonoscopic polypectomy to at least 5 yr
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DOI：
10.1111/j.1572-0241.2007.01231.x
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发表时间：
2007-08-01
影响因子：
9.8
通讯作者：
Hoffmeister, Michael
中科院分区：
文献类型：
--
作者：
Brenner, Hermann;Chang-Claude, Jenny;Hoffmeister, Michael
目的：结肠镜下切除息肉可显著降低结直肠癌（CRC）的发病率和死亡率。推荐的结肠镜检查监测时间间隔因国家而异，最近在美国大多数病例中延长至5年或更长时间。而以前的证据主要是基于腺瘤复发的观察，我们的目的是评估风险CRC发生的时间，因为polypectomy.Methods：在人口为基础的病例对照研究在德国进行，详细的历史和以前的大肠内窥镜检查的结果，通过采访和医疗记录。根据454例CRC患者和391例匹配对照组的息肉切除术后时间，评估了有内镜息肉切除术史的受试者与既往无大肠内镜检查的受试者相比发生CRC的风险。比值比（95%置信区间）的CRC长达2年，3-5年，息肉切除术后6-10年（使用既往未接受内镜检查的受试者作为参考组）分别为0.16（0.09-0.69）、0.27（0.08-0.87）和1.90（0.67-5.43）。即使在检测和切除高危息肉（3+息肉，至少1个息肉>= 1 cm，至少1个息肉具有绒毛成分）后，5年内风险也显著降低（比值比0.27，95%置信区间0.10-0.77）。优势比（95%的置信区间）为整个10年的时间间隔息肉切除术后分别为0.50（0.23-1.12）和0.36（0.18-0.76）的患者记录的高风险腺瘤和其他patients.Conclusions：我们的研究提供了经验支持结肠镜息肉切除术后的监测间隔延长到至少5年。
Objective: Colonoscopy with removal of polyps may strongly reduce colorectal cancer (CRC) incidence and mortality. Recommended time intervals to surveillance colonoscopy differ between countries and have recently been extended to 5 yr or longer for the majority of cases in the United States. Whereas previous evidence is mainly based on observations of adenoma recurrence, we aimed to assess risk of CRC occurrence according to time since polypectomy.Methods: In a population-based case-control study conducted in Germany, detailed history and results of previous large bowel endoscopies were obtained by interview and from medical records. Risk of CRC among subjects with history of endoscopic polypectomy compared to subjects without previous large bowel endoscopy was assessed according to time since polypectomy among 454 cases with CRC and 391 matched controls.Results: Odds ratios (95% confidence intervals) of CRC up to 2 yr, 3-5 yr, and 6-10 yr after polypectomy (using subjects without previous endoscopy as reference group) were 0.16 (0.09-0.69), 0.27 (0.08-0.87), and 1.90 (0.67-5.43), respectively. Risk was significantly reduced (odds ratio 0.27, 95% confidence interval 0.10-0.77) within 5 yr even after detection and removal of high-risk polyps (3+ polyps, at least 1 polyp >= 1 cm, at least 1 polyp with villous components). Odds ratios (95% confidence intervals) for the entire 10-yr time interval following polypectomy were 0.50 (0.23-1.12) and 0.36 (0.18-0.76) for patients with recorded high-risk adenomas and other patients, respectively.Conclusions: Our study provides empirical support for extension of the surveillance interval after colonoscopic polypectomy to at least 5 yr.