Likelihood of missed and recurrent adenomas in the proximal versus the distal colon.
Likelihood of missed and recurrent adenomas in the proximal versus the distal colon.
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DOI：
10.1016/j.gie.2011.02.023
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发表时间：
2011-08
影响因子：
7.7
通讯作者：
Cross AJ
中科院分区：
文献类型：
--
作者：
Laiyemo AO;Doubeni C;Sanderson AK 2nd;Pinsky PF;Badurdeen DS;Doria-Rose VP;Marcus PM;Schoen RE;Lanza E;Schatzkin A;Cross AJ
与远端结肠相比，结肠镜检查在降低近端结肠直肠癌死亡率方面可能不太有效。近端结肠腺瘤漏诊和复发的可能性更大可能导致这种现象。检查近端腺瘤是否与漏诊和复发腺瘤的风险和位置相关。前瞻性息肉预防试验 1,864 名基线时患有腺瘤的患者在四年后接受了随访结肠镜检查（腺瘤复发）。其中，1,731 人在基线检查一年后接受了透明结肠镜检查（漏检腺瘤）。基线腺瘤位置与一年和四年后进行结肠镜检查时发现的腺瘤风险和位置之间的关联。在第 1 年进行结肠镜检查时，598 名 (34.6%) 患者患有腺瘤（漏诊腺瘤）。与基线时仅患有远端腺瘤的患者相比，基线时仅患有近端腺瘤的患者更有可能漏诊腺瘤（相对风险（RR）=1.28；95%置信区间（CI）：1.09-1.49）和仅漏诊近端腺瘤（RR=2.05；95%CI：1.49-2.80）。在第 4 年进行结肠镜检查时，733 名患者 (39.3%) 出现腺瘤复发。基线仅近端腺瘤的患者更有可能出现任何腺瘤复发（RR=1.14；95%CI：1.00-1.31）和仅近端腺瘤复发（RR=1.52；95%CI：1.15-2.02）。涉及遗漏腺瘤的敏感性分析并未对第四年结肠镜检查时复发腺瘤的风险或位置产生重大影响。重复结肠镜检查仍可能漏掉病变。漏诊和复发的腺瘤更有可能位于近端结肠。
Colonoscopy may be less efficacious in reducing colorectal cancer mortality in the proximal as compared with the distal colon. A greater likelihood for missed and recurrent adenomas in the proximal colon may contribute to this phenomenon. To examine whether a proximal adenoma is associated with the risk and location of missed and recurrent adenomas. Prospective Polyp Prevention Trial 1,864 patients with adenoma at baseline underwent a follow-up colonoscopy four years later (adenoma recurrence). Of these, 1,731 underwent a clearing colonoscopy one year after the baseline examination (missed adenoma). Association of baseline adenoma location with the risk and location of adenomas found at colonoscopy performed one year and four years later. At the year 1 colonoscopy, 598 (34.6%) patients had an adenoma (missed adenoma). Compared with those with distal only adenoma at baseline, patients with proximal only adenoma at baseline were more likely to have any missed adenoma (relative risk (RR)=1.28; 95% confidence interval (CI): 1.09–1.49) and proximal only missed adenoma (RR=2.05; 95%CI: 1.49–2.80). At the year 4 colonoscopy, 733 (39.3%) patients had an adenoma recurrence. Patients with baseline proximal only adenoma were more likely to have any adenoma recurrence (RR=1.14; 95%CI: 1.00–1.31) and proximal only adenoma recurrence (RR=1.52; 95%CI: 1.15–2.02). Sensitivity analyses involving missed adenomas did not materially affect the risk or location of recurrent adenomas at year four colonoscopy. Lesions may still be missed with repeated colonoscopies. Missed and recurrent adenomas are more likely to be in the proximal colon.