Minimal benefit of earlier-than-recommended repeat colonoscopy among US Medicare enrollees following a negative colonoscopy.
Minimal benefit of earlier-than-recommended repeat colonoscopy among US Medicare enrollees following a negative colonoscopy.
复制标题
对于结肠镜检查阴性后的美国医疗保险参保者来说，早于建议的重复结肠镜检查的好处微乎其微。
DOI：
10.1111/apt.12902
复制
发表时间：
2014
影响因子：
7.6
通讯作者：
Lewis,JD
中科院分区：
文献类型：
--
作者：
Yang,Y-X;French,B;Localio,AR;Brensinger,CM;Lewis,JD
背景很大一部分美国医疗保险受益人在结肠镜检查阴性后接受了早于推荐的随访结肠镜检查。这种做法需要大量的成本和增加的risk.AimsTo比较结肠镜检查阴性后不同的随访结肠镜检查时间间隔相关的结直肠癌（CRC）的风险，并确定较短的结肠镜检查随访时间间隔的潜在益处是否会因性别而异。流行病学和最终结果-医疗保险链接数据库（1991-2006），932 370名医疗保险注册者代表整个美国老年人口。我们比较了结肠镜检查阴性后在不同时间间隔接受随访结肠镜检查的患者中CRC的累积发病率。主要结果是事件CRC.ResultsThe合格的研究队列（n= 480 864）包括106 924例患者接受≥1次结肠镜检查。男性在首次结肠镜检查中比女性更可能需要息肉切除术。与推荐的9-10年随访结肠镜检查间隔相比，5-6年的间隔与最大的CRC累积风险降低相关[即0.17%（95% CI：0.009-0.32%）]。与较短的结肠镜随访间隔相关的风险降低幅度在男性和女性之间没有显著差异。ConclusionsAmong older individuals who experienced a negative colonoscopy，由早于推荐的随访结肠镜检查提供的累积CRC风险降低幅度相当小，可能无法证明增加结肠镜检查频率的风险和成本是合理的。此外，男女之间的差异不足以保证提出针对性别的建议。
BackgroundA large proportion of US Medicare beneficiaries undergo earlier‐than‐recommended follow‐up colonoscopies after negative screening colonoscopy. Such practice entails substantial cost and added risk.AimsTo compare the risk of colorectal cancer (CRC) associated with varying follow‐up colonoscopy intervals following a negative colonoscopy, and to determine whether the potential benefit of a shorter colonoscopy follow‐up interval would differ by gender.MethodsWe conducted a weighted cohort study using the Surveillance, Epidemiology and End Results‐Medicare linked database (1991–2006) among 932 370 Medicare enrollees who are representative of the entire US elderly population. We compared the cumulative incidence of CRC among patients who underwent follow‐up colonoscopies at different intervals following a negative colonoscopy. The primary outcome was incident CRC.ResultsThe eligible study cohort (n= 480 864) included 106 924 patients who underwent ≥1 colonoscopy. Men were more likely to require polypectomy during their initial colonoscopy than women. Compared to the recommended 9–10 year follow‐up colonoscopy interval, an interval of 5–6 years was associated with the largest CRC cumulative risk reduction [i.e. 0.17% (95% CI: 0.009–0.32%)]. The magnitude of risk reduction associated with shorter colonoscopy follow‐up intervals was not significantly different between men and women.ConclusionsAmong elderly individuals who undergo a negative colonoscopy, the magnitude of reduction in the cumulative CRC risk afforded by earlier‐than‐recommended follow‐up colonoscopy is quite small, and probably cannot justify the risk and cost of increased colonoscopy frequency. In addition, there are insufficient differences between men and women to warrant gender‐specific recommendations.