Does a negative screening colonoscopy ever need to be repeated?
Does a negative screening colonoscopy ever need to be repeated?
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DOI：
10.1136/gut.2005087130
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发表时间：
2006-08-01
期刊：
影响因子：
24.5
通讯作者：
Hoffmeister, M.
中科院分区：
文献类型：
--
作者：
Brenner, H.;Chang-Claude, J.;Hoffmeister, M.
背景和目的：结肠镜筛查被认为是降低结直肠癌发病率和死亡率的一种有效且经济的工具。对于结肠镜检查阴性的患者是否以及何时需要再次进行结肠镜检查还没有明确的定义。本研究的目的是评估长期的风险，临床表现为结直肠癌的受试者与阴性结果在colonoscopic.Patients：380例和485对照参与人口为基础的病例对照研究在德国。方法：详细的历史和结果，以前的结肠镜检查，通过访谈和医疗记录。根据结肠镜检查后的时间估计既往结肠镜检查阴性受试者与既往未行结肠镜检查受试者之间结直肠癌的校正相对危险度。结果：既往结肠镜检查阴性受试者的结直肠癌风险比既往未行结肠镜检查的受试者低74%（校正比值比（aOR）= 0.26（95%置信区间，0.16 ~ 0.40））。即使结肠镜检查已经进行了20年或更长时间，也可以看到这种低风险。sigma癌症的风险特别低（aOR = 0.13（0.04 - 0.43））和直肠癌（aOR = 0.19（0.09至0.39）），在55到64岁的时候，（aOR = 0.17（0.08 - 0.39））及以上（aOR = 0.21（0.10 ~ 0.41））。结肠镜检查阴性的受试者患结直肠癌的风险非常低，可能不需要重复结肠镜检查20年或更多，如果有的话。将筛查间隔延长至20年或更长时间的可能性可能会减少并发症，并增加基于结肠镜检查的筛查计划的可行性和成本效益。
Background and aims: Screening colonoscopy is thought to be a powerful and cost-effective tool to reduce colorectal cancer incidence and mortality. Whether and when colonoscopy with negative findings has to be repeated is not well defined. The aim of this study was to assess the long term risk of clinically manifest colorectal cancer among subjects with negative findings at colonoscopy.Patients: 380 cases and 485 controls participating in a population based case-control study in Germany.Methods: Detailed history and results of previous colonoscopies were obtained by interview and from medical records. Adjusted relative risks of colorectal cancer among subjects with a previous negative colonoscopy compared with those without previous colonoscopy were estimated according to time since colonoscopy.Results: Subjects with previous negative colonoscopy had a 74% lower risk of colorectal cancer than those without previous colonoscopy (adjusted odds ratio (aOR) = 0.26 (95% confidence interval, 0.16 to 0.40)). This low risk was seen even if the colonoscopy had been done up to 20 or more years previously. Particularly low risks were seen for sigma cancer (aOR = 0.13 (0.04 to 0.43)) and for rectal cancer (aOR = 0.19 (0.09 to 0.39)), and after a negative screening colonoscopy at ages 55 to 64 (aOR = 0.17 (0.08 to 0.39)) and older (aOR = 0.21 (0.10 to 0.41)).Conclusions: Subjects with negative findings at colonoscopy are at very low risk of colorectal cancer and might not need to undergo repeat colonoscopy for 20 years or more, if at all. The possibility of extending screening intervals to 20 years or more might reduce complications and increase the feasibility and cost-effectiveness of colonoscopy based screening programmes.