Risk Stratification Tool for Colorectal Polyp Surveillance

肠癌筛查用于在没有症状的患者中发现肠癌和称为息肉的癌前病变。筛查的目的既是为了及早发现肠癌--使它们更容易成功治疗--也是为了通过切除癌前息肉来预防癌症。虽然英国各地的检查时间各不相同，但一定年龄的成年人会被邀请提交一份邮寄粪便样本，如果检测到血迹，他们会被邀请进行一项名为结肠镜检查的详细测试。在结肠镜检查中，约有1/20的人被发现患有癌症，1/3的人患有息肉。尽管在最初的结肠镜检查中切除了息肉，但约有一半的患者将继续发展为未来的息肉，因此患者被要求在未来再次进行结肠镜检查，以寻找新的息肉。临床医生有指南来帮助决定谁需要进一步的结肠镜检查以及他们需要的时间。然而，这些指南在预测未来谁有可能形成新的息肉方面并不是很准确，很多人接受结肠镜检查，但他们没有进一步的息肉。结肠镜检查要求患者事先服用强力泻药，并在手术过程中服用镇静剂。出现严重并发症的风险很小。此外，患者需要至少住院一天，并限制第二天开车和工作。许多患者觉得他们不舒服，他们在医院内消耗了大量资源，对NHS和整个社会来说都是昂贵的。这项由格拉斯哥大学与NHS大格拉斯哥和克莱德共同领导的项目将通过结合显微镜下息肉具体变化的数据以及通过观察息肉的基因突变来更准确地预测哪些患者未来会发展成新的息肉。利用NHSGGC苏格兰肠癌筛查计划收集的现有数据和息肉组织，我们将开发一种新工具，以更好地预测进一步的息肉。总体而言，这一新工具可以减少需要重复结肠镜检查的人数，减少不愉快的经历和并发症，通过减少监测名单改善获得结肠镜检查的机会，并降低NHS和英国的成本，同时为大肠息肉患者保持安全的随访制度。

Bowel cancer screening is used to find bowel cancer and pre-cancerous lesions called polyps in patients without symptoms. The aim of screening is both to catch bowel cancers early -- making them easier to treat successfully -- and to prevent cancers by removing pre-cancerous polyps. Although timings vary across the UK, adults at a certain age are invited to submit a postal stool sample, and if traces of blood are detected, they are invited to a detailed test called colonoscopy.At colonoscopy, around 1 in 20 people are found to have cancer, while 1 in 3 have a polyp. Around a half of patients will go on to develop future polyps despite their removal at initial colonoscopy and therefore patients are asked to return for another colonoscopy in the future to look for new polyps. Guidelines exist for clinicians to help decide who needs a further colonoscopy and when they need it. However, these guidelines are not very accurate in predicting who is likely to form new polyps in the future, and a lot of people undergo colonoscopy who do not have a further polyp.Colonoscopies require patients to take powerful laxatives beforehand and sedatives during the procedure. There is a small risk of serious complication. Furthermore, patients need to attend hospital for at least one day, and are restricted with regards to driving and work the next day. Many patients find them unpleasant, they use a lot of resource within hospitals, and are costly to the NHS and society as a whole.This project, led by the University of Glasgow with NHS Greater Glasgow and Clyde, will more accurately predict which patients will develop new polyps in the future, by combining data about specific changes in the polyp when looking under the microscope, and by looking at the genetic mutations of the polyps. Using existing data and polyp tissue collected by the Scottish Bowel Cancer Screening Programme in NHSGGC we will develop a new tool to better predict further polyps.Overall this new tool could reduce the number of people needing repeated colonoscopy, reducing unpleasant experiences and complications, improving access to colonoscopy by reducing surveillance lists, and reducing costs to the NHS and the UK, while maintaining a safe follow up regime for patients who have had a large bowel polyp.