Colonoscopy Identifies Increased Prevalence of Large Polyps or Tumors in Patients 40-49 Years Old With Hematochezia vs Other Gastrointestinal Indications.
Colonoscopy Identifies Increased Prevalence of Large Polyps or Tumors in Patients 40-49 Years Old With Hematochezia vs Other Gastrointestinal Indications.
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DOI：
10.1016/j.cgh.2015.12.046
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发表时间：
2016-06
期刊：
影响因子：
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通讯作者：
Lieberman D
中科院分区：
文献类型：
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作者：
Saks K;Enestvedt BK;Holub JL;Lieberman D
结肠镜检查在评估50岁以下有症状的个体中的作用尚不清楚。我们的目标是确定40-49岁因各种体征和症状接受结肠镜检查的人中大息肉(>；9 mm)或肿瘤的患病率，并将结果与50-54岁接受筛查结肠镜检查的中等风险个人的结果进行比较。我们收集了2000年至2012年全国内窥镜检查数据库的数据，确定了40-49岁接受结肠镜检查的患者是否有出血和非出血指征。将大息肉(>；9 mm)或肿瘤的患病率与对照组(n=99,713名50至54岁接受结肠镜检查的平均风险个体)进行比较。共有65,892名年龄在40-49岁之间的患者接受了各种适应症的结肠镜检查。患有便血但无贫血或缺铁性贫血(IDA)的男性和女性患者患大息肉或肿瘤的比例(7.2%)显著高于对照组(男性：7.2%对6.2%；P=.0001；女性：5.5%对4.1%；P<；.0001)。体重减轻、贫血或缺铁性贫血、便血伴贫血或缺铁性贫血的患者，其大息肉或肿瘤的患病率并不显著高于对照组。与对照组(男性：3.9%比6.2%；P<；0.0001；女性：2.7%比4.1%；P<；.0001)相比，有一般胃肠道症状(疼痛、腹胀或大便习惯改变)的患者发生晚期肿瘤的比例显著降低。一项对国家内窥镜检查数据库的分析支持结肠镜检查在评估40-49岁患者便血方面的作用。与50-54岁的中等风险患者相比，有贫血、体重减轻和一般腹部症状的患者有较大息肉或肿瘤的比例较低。50岁以下有全身胃肠道症状的患者中有大息肉的比例明显较低，因此这些患者从结肠镜检查中受益的可能性较小。
There is an unclear role for colonoscopy in evaluation of symptomatic individuals younger than 50 years old. We aimed to determine the prevalence of large polyps (>9 mm) or tumors in individuals 40–49 years old who underwent colonoscopy for various signs and symptoms, and compare the results with those from average-risk individuals age 50–54 years old who underwent screening colonoscopy. We collected data from a national endoscopy database, 2000 through 2012, and identified patients 40–49 years old who underwent colonoscopy for bleeding and nonbleeding indications. The prevalence of large polyps (>9 mm) or tumors was compared to the prevalence in a reference group (n=99,713 average-risk individuals age 50 to 54 undergoing screening colonoscopy). A total of 65,892 patients 40–49 years old underwent colonoscopy for a variety of indications. Significantly larger proportions of male and female patients with hematochezia without anemia or iron deficiency anemia (IDA) had large polyps or tumors (7.2%) compared to the reference group (men: 7.2% vs 6.2%; P=.0001 and women: 5.5% vs 4.1%; P<.0001). Patients with weight loss, anemia or IDA, or hematochezia with anemia or IDA did not have a significantly higher prevalence of large polyps or tumors than the reference group. Significantly lower proportions of patients with general gastrointestinal symptoms (pain, bloating, or change in bowel habits) had advanced neoplasia compared to the reference group (men: 3.9% vs 6.2%; P<.0001 and women: 2.7% vs 4.1%; P<.0001). An analysis of a national endoscopy database supports the role of colonoscopy to evaluate hematochezia in patients 40–49 years old. A lower proportion of patients with anemia, weight loss, and general abdominal symptoms had large polyps or tumors compared to average-risk patients, 50–54 years old. A significantly lower proportion of patients younger than 50 years with general gastrointestinal symptoms had large polyps—these patients are therefore less likely to benefit from colonoscopy.