Gaitada gizli kan testi pozitifliği nedeni ile kolonoskopi yapılan hastaların kolonoskopik ve patolojik sonuçlarının değerlendirilmesi

Year 2018, Volume: 17 Issue: 1, 17 - 20, 24.04.2018

Özlem Gül Utku Bilal Ergül , Dilek Oğuz

https://doi.org/10.17941/agd.431639

Cited By: 4

Abstract

Giriş ve Amaç: Kolorektal kanser taramasında gaitada gizli kan testi dışında, fekal immünokimyasal test, fleksible sigmoidoskopi ve kolonoskopi kullanılan diğer yöntemlerdir. Bu çalışmada gaitada gizli kan testi pozitif olması nedeni ile kolonoskopi istenmiş olan hastaların kolonoskopik ve patolojik bulgularını değerlendirmeyi amaçladık. Gereç ve Yöntem: Bu çalışmaya Haziran 2014-Ekim 2016 yılları arasında gaitada gizli kan testi pozitif saptanan ve kolonoskopi yapılması için Ahi Evran Üniversitesi Eğitim ve Araştırma Hastanesi endoskopi ünitesine yönlendirilen hastalar alındı. Yetersiz kolon temizliği, aktif hematokezyası, kolon operasyonu öyküsü, inflamatuvar barsak hastalığı öyküsü veya üst gastrointestinal sistem endoskopisinde kanamaya neden olabilecek lezyonu olan hastalar çalışma dışı bırakıldı. Hastaların yaşları, cinsiyetleri, kolonoskopik bulguları, patoloji sonuçları not edildi. Üç ya da daha fazla polip, 1 cm’den büyük adenomatöz polip, patolojik incelemede villöz komponent içeren ya da yüksek dereceli displazi saptanan hastalar yüksek riskli grup olarak değerlendirildi ve bu kriterlere göre kolon kansertarama programına alındı. Bulgular: Çalışmaya toplam 225 hasta dâhil edildi. Hastaların 111’i (%49.3) erkek, 114’ü (%50.7) kadın, ortalama yaşları 58.52 (24-90), ortalama hemoglobin düzeyi 13.63 (7.2-18) idi. Endoskopik tanıları; normal kolonoskopik bulgular 86 (%38,2), polip 59 (%26,2) , yalnızca perianal hastalık 27 (%12), divertikül 16 (%7,1), kolon kanseri 14 (%6,2), inflamatuvar barsak hastalığı 14 (%6,2), enfeksiyöz kolit 6 (%2,7), anjiodisplazi 3 (%1,3) hasta şeklinde idi. Endoskopik olarak kolon kanseri düşünülen ve polip saptanan 73 (%32,4) hastanın patoloji sonuçları; tübüler adenom 31 (%42,5), adenokarsinom 17 (%23,3), hiperplastik polip 16 (%21,9), tübülovillöz adenom 7 (%9,6), serrated adenom 2 (%2,7) şeklinde değerlendirildi. Kolonoskopik olarak polip saptanan 3 (%5,08) hastanın patolojisinde erken evre karsinom saptandı. Polip saptanan 59 hastanın 30’u (%50,8) yüksek riskli, 29’u (%49,2) düşük riskli olarak bulundu. Sonuç: Gaitada gizli kan testi pozitifliği ile gelen hastaların yaklaşık yarısında kolon patolojisi tespit edilmiştir. Bu test, kolon kanseri ve öncül lezyonlarının tespitinde olduğu gibi, subklinik inflamatuvar barsak hastalığı, kronik kan kaybına yol açan divertikül, anjiodisplazi gibi patolojilerin de tespitinde yardımcı olan ucuz, kolay uygulanabilir bir yöntemdir.

Keywords

Gaitada gizli kan testi, kolonoskopi, kolorektal kanser, polip

Evaluation of colonoscopic and pathological outcomes of patients who have undergone colonoscopy with a positive fecal occult blood screening test

Abstract

Background and Aims: Methods such as guaiac fecal occult blood-screening test, fecal immunological test, colonoscopy, and sigmoidoscopy are generally used in colorectal screening programs. The aim of this study was to evaluate the colonoscopic and pathological findings of patients with a g-fecal occult blood-screening test-positive result. Materials and Methods: This study was conducted between June 2014 and October 2016 on patients who were referred to Ahi Evran University Training and Research Hospital endoscopy unit after a positive stool blood test and then underwent colonoscopy. The exclusion criteria were inadequate colon cleansing, active hematochezia, a history of colonic surgery, inflammatory bowel disease, or any lesion that may lead to hemorrhage in the upper gastrointestinal system. Age, sex, and colonoscopic and pathological findings of the study participants were recorded. Patients with three or more polyps, an adenomatous polyp measuring >1 cm in diameter, pathological examination involving the villous component, or high-grade dysplasia were evaluated as the high-risk group. These patients attended the colon cancer screening program. Results: A total of 225 patients, including 111 (49.3%) males, were recruited in the study. The mean age was 58.52 (range: 24-90) years. Mean hemoglobin levels were 13.63 (range: 7.2-18) g/dl. Endoscopic findings of these patients included normal colonoscopy [86 patients (38.2%)], polyps [59 patients (26.2%)], perianal disease [27 patients (12%)], diverticulum [16 patients (7.1%)], colon cancer [14 patients (6.2%)], inflammatory bowel disease [14 patients (6.2%)], infectious colitis [6 patients (2.7%)], and angiodysplasia [3 patients (1.3%)]. Pathological findings of 73 (32.4%) patients who were diagnosed with colon cancer and polyps through endoscopy wereas follows: tubular adenoma [31 patients (42.5%)], adenocarcinoma [17 patients (23.3%)], hyperplastic polyps [16 patients (21.9%)], tubulovillous adenoma [7 patients (9.6%)], and serrated adenoma [2 patients (2.7%)]. Early-stage carcinoma was diagnosed in the pathology of 3 (5.08%) patients who had colonoscopically detected polyps. Of the 59 patients who were diagnosed with polyps, 30 (50.8%) patients were at high risk and 29 (49.2%) were at low risk. Conclusion: Colonic pathology was detected in about half of the patients positive for g-fecal occult blood-screening test. This test is not only an inexpensive and easily applicable method for colon cancer screening, but it is also helpful for the detection of pathologies that could lead to chronic blood loss, such as subclinical inflammatory bowel disease, diverticulitis, and angiodysplasia.

Keywords

Fecal occult blood screening test, colonoscopy, colorectal cancer, polyp

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