Factors Predictive of High-Risk Adenomas at the Third Colonoscopy after Initial Adenoma Removal
Factors Predictive of High-Risk Adenomas at the Third Colonoscopy after Initial Adenoma Removal
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DOI：
10.3346/jkms.2013.28.9.1345
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发表时间：
2013-09-01
影响因子：
4.5
通讯作者：
Kim, Won Ho
中科院分区：
文献类型：
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作者：
Chung, Sook Hee;Park, Soo Jung;Kim, Won Ho
根据先前的两次结肠镜检查评估第三次结肠镜检查中高危腺瘤的预测因素可能有助于评估第三次结肠镜检查中的高危腺瘤。我们分析了1997年1月至2011年1月在Severance医院就诊的131例患者的临床资料。在最初的结肠镜检查中切除腺瘤后，所有患者都接受了两次结肠镜检查。在第一次和第二次结肠镜检查高危腺瘤的20名患者中，10名(50%)患者在第三次结肠镜检查时有高危腺瘤。在第一次或第二次结肠镜检查仅有一次高危腺瘤的67例患者中，15例(22.4%)患者在第三次结肠镜检查时出现高危腺瘤，而在44例第一次和第二次结肠镜检查未发现高危腺瘤的患者中，仅有1例(2.3%)在第三次结肠镜检查时出现高危腺瘤(P<；0.001)。多因素时间相关协变量COX回归分析证实，第一次和/或第二次结肠镜检查时高危腺瘤(HR，9.56；95%CI，2.37~38.54；P=0.002)是第三次结肠镜检查时高危腺瘤的独立预测因素。考虑到这些发现，来自之前两次结肠镜检查而不是一次先前检查的数据可能有助于在第三次结肠镜检查时确定需要仔细进行结肠镜检查的高危人群。
Evaluating predictive factors for high-risk adenomas at the third colonoscopy based on two prior colonoscopies may help evaluate high-risk adenoma at the third colonoscopy. We analyzed clinical data of 131 patients at Severance Hospital from January 1997 to January 2011. All of them underwent two subsequent colonoscopies after removal of adenomas during an initial colonoscopy. Among 20 patients with high-risk adenoma at the first and second colonoscopies, 10 (50%) patients had high-risk adenoma at the third colonoscopy. Among the 67 patients who had high-risk adenoma only once at the first or second colonoscopy, 15 (22.4%) patients had high-risk adenoma at the third colonoscopy but among the 44 patients without high-risk adenoma at the first and second colonoscopies, only 1 (2.3%) patient had high-risk adenoma at the third colonoscopy (P < 0.001). A multivariate time dependent covariate Cox regression analysis confirmed that high-risk adenoma at the first and/or second colonoscopy (HR, 9.56; 95% CI, 2.37-38.54; P = 0.002) was independent predictor of high-risk adenoma at the third colonoscopy. Given these findings, data from two prior colonoscopies, not one prior examination, may help identify high-risk populations at the third colonoscopy who require careful colonoscopic surveillance.