Utilization and yield of surveillance colonoscopy in the continued follow-up study of the polyp prevention trial.
Utilization and yield of surveillance colonoscopy in the continued follow-up study of the polyp prevention trial.
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DOI：
10.1016/j.cgh.2008.12.009
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发表时间：
2009-05
期刊：
影响因子：
--
通讯作者：
Schoen RE
中科院分区：
文献类型：
--
作者：
Laiyemo AO;Pinsky PF;Marcus PM;Lanza E;Cross AJ;Schatzkin A;Schoen RE
关于监测性结肠镜检查的使用和产量的前瞻性信息是有限的。在为期4年的饮食干预试验结束后，我们在息肉预防试验（PPT）的参与者中检查了监测结肠镜检查的利用率和产量。对1,297名参与者进行了跟踪调查。我们计算了试验后结肠镜检查的累积概率，并研究了平均随访时间为5.9年的腺瘤和晚期腺瘤复发的发生率和预测因素。774例受试者（59.7%）接受了重复结肠镜检查。在基线时患有低风险腺瘤（1-2个非晚期腺瘤）且PPT结束时无腺瘤复发（最低风险类别）的431例受试者中，30.3%在4年内接受了重复结肠镜检查。在基线时和PPT结束时再次发生高风险腺瘤（晚期腺瘤和/或≥3例非晚期腺瘤）的55例受试者中（最高风险类别），41.3%在3年内接受了结肠镜检查，63.5%在5年内接受了检查。晚期腺瘤6年的累积发生率在最低风险类别中为3.6%，在最高风险类别中为38.9%，在中等风险类别中为6.6%至13.8%。PPT结束时结肠镜检查时的晚期腺瘤与监测期间的晚期腺瘤复发显著相关（HR=6.2; 95% CI：2.5-15.4）。监测结肠镜检查在低风险受试者中过度使用，而在高风险受试者中使用不足。晚期腺瘤的发生率与腺瘤风险类别相对应。通过将利用率与腺瘤复发的风险结合起来，可以更好地管理资源消耗。
Prospective information on use and yield of surveillance colonoscopy is limited. We examined utilization and yield of surveillance colonoscopy among participants in the Polyp Prevention Trial (PPT) after the 4-year dietary intervention trial ended. A cohort of 1,297 participants was followed. We calculated the cumulative probability of post-trial colonoscopy and investigated the yield and predictive factors for adenoma and advanced adenoma recurrence over a mean follow-up time of 5.9 years. Seven-hundred and seventy-four subjects (59.7%) had a repeat colonoscopy. Among 431 subjects with low-risk adenomas (1-2 non-advanced adenomas) at baseline and no adenoma recurrence at the end of the PPT (lowest-risk category), 30.3% underwent a repeat colonoscopy within 4 years. Among 55 subjects who had high-risk adenomas (advanced adenoma and/or ≥3 non-advanced adenomas) at baseline and again at the end of the PPT (highest-risk category), 41.3% had a colonoscopy within 3 years and 63.5% had an examination within 5 years. The cumulative yield of advanced adenoma through 6 years was 3.6% for the lowest-risk category, 38.9% for the highest-risk category, and ranged from 6.6% to 13.8% for intermediate-risk categories. An advanced adenoma at the colonoscopy at the end of the PPT was significantly associated with an advanced adenoma recurrence during surveillance (HR=6.2; 95% CI: 2.5-15.4). Surveillance colonoscopy was over-utilized for low-risk subjects and under-utilized for high-risk subjects. Advanced adenoma yield corresponded with the adenoma risk category. Resource consumption can be better managed by aligning utilization with the risk of adenoma recurrence.
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