RANDOMIZED COMPARISON OF SURVEILLANCE INTERVALS AFTER COLONOSCOPIC REMOVAL OF NEWLY DIAGNOSED ADENOMATOUS POLYPS
RANDOMIZED COMPARISON OF SURVEILLANCE INTERVALS AFTER COLONOSCOPIC REMOVAL OF NEWLY DIAGNOSED ADENOMATOUS POLYPS
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DOI：
10.1056/nejm199304013281301
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发表时间：
1993-04-01
影响因子：
158.5
通讯作者：
SHIKE, M
中科院分区：
文献类型：
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作者：
WINAWER, SJ;ZAUBER, AG;SHIKE, M
背景。腺瘤性息肉的识别和切除以及息肉切除术后的监测被认为对结直肠癌的控制很重要。在目前的实践中，息肉切除术后结肠镜检查的间隔是可变的，通常长达一年，并且不是基于随机临床试验的数据。我们试图确定随访3年的结肠镜检查是否能发现重要的结肠病变，以及随访1年和3年的结肠镜检查。如果患者患有一个或多个腺瘤，以前没有息肉切除术，并且进行了完整的结肠镜检查，并且所有息肉都已切除，则符合条件。他们被随机分配在1年和3年或仅3年随访结肠镜检查。两个研究终点分别是任何腺瘤的检测，以及具有晚期病理特征的腺瘤的检测（定义为直径为10 ~ 1cm的腺瘤和高度不典型增生或浸润性癌）。在2632例符合条件的患者中，1418例随机分为两个随访组，699例分为两次检查组，719例分为一次检查组。1年和3年检查组中腺瘤患者的百分比为41.7%，而3年检查组中腺瘤患者的百分比为32.0% （P = 0.006）。两组患者中具有晚期病理特征的腺瘤比例相同（3.3%）。结肠镜切除腺瘤性息肉3年后进行结肠镜检查，与随访1年和3年后进行结肠镜检查一样有效。建议在新诊断的腺瘤性息肉结肠镜切除后随访检查至少间隔三年。在全国范围内采用这一建议将减少息肉切除术后监测和筛查的费用。
Background. The identification and removal of adenomatous polyps and post-polypectomy surveillance are considered to be important for the control of colorectal cancer. In current practice, the intervals between colonoscopies after polypectomy are variable, often a year long, and not based on data from randomized clinical trials. We sought to determine whether follow-up colonoscopy at three years would detect important colonic lesions as well as follow-up colonoscopy at both one and three years.Methods. Patients were eligible if they had one or more adenomas, no previous polypectomy, and a complete colonoscopy and if all their polyps had been removed. They were randomly assigned to have follow-up colonoscopy at one and three years or at three years only. The two study end points were the detection of any adenoma, and the detection of adenomas with advanced pathological features (defined as those >1 cm in diameter and those with high-grade dysplasia or invasive cancer).Results. Of 2632 eligible patients, 1418 were randomly assigned to the two follow-up groups, 699 to the two-examination group and 719 to the one-examination group. The percentage of patients with adenomas in the group examined at one and three years was 41.7 percent, as compared with 32.0 percent in the group examined at three years (P = 0.006). The percentage of patients with adenomas with advanced pathological features was the same in both groups (3.3 percent).Conclusions. Colonoscopy performed three years after colonoscopic removal of adenomatous polyps detects important colonic lesions as effectively as follow-up colonoscopy after both one and three years. An interval of at least three years is recommended before follow-up examination after colonoscopic removal of newly diagnosed adenomatous polyps. Adoption of this recommendation nationally should reduce the cost of post-polypectomy surveillance and screening.