Is There any Benefit of Making Early Follow-up of Colonoscopic Polypectomy According to Recommendations?
Öz
Backgrounds and Aim: After the colonoscopic polypectomy, patients were followed-up according to international guidelines. In this study, we aimed to determine whether there was compliance with follow-up intervals as specified by the guidelines. Also, we researched whether there is any beneficial effect of reduced follow-up intervals for detecting AAP and/or colon carcinoma. Material and Methods: Patients who had a colonoscopy between January 2008 and December 2015 in Türkiye Yüksek İhtisas Training and Research Hospital, Gastroenterology Department, Endoscopy Unit were enrolled in the study. Patients who had detected adenoma on their first colonoscopy were divided into two groups: Group A and Group B. In Group A, colonoscopic surveillance was performed earlier according to the current guideline, and in Group B, colonoscopic surveillance was performed properly according to the current guideline. Between the two groups, the detection rate of AAP and/or colon carcinoma were compared. Results: Overall, 270 patients (mean age: 56.8 years) were included in the study. At their first colonoscopies, 759 polyps, 528 adenomas, and 95 AAPs were detected. In our clinical practice, the interval between the first and second colonoscopy was 21 months. Group A had 228 patients (84.1%), and Group B had 42 patients (15.9%). Between the two groups, the detection rates of AAP and cancer could be compared. Between the two groups, the presence of AAP (6.6% vs. 11.9%; p = 0.2) and colon carcinoma (0.4% vs. 0%; p = 1.0) was not different. Conclusion: Compared with current guidelines, reduced follow-up intervals between the first and second colonoscopies are not associated with conferring additional beneficial effects to patients.
Anahtar Kelimeler
Kaynakça
- 1- Zauber AG, Winawer SJ, O'Brien MJ, et al. Colonoscopicpolypectomyandlong-termprevention of colorectal-cancerdeaths. N Engl J Med. 2012;366(8):687–696. 2- Levin B, Lieberman DA, McFarland B, et al. Screenin g and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008:a joint guideline from the American Cancer Society, the US Multi-SocietyTask Force on Colorectal Cancer, and the American College of Radiology.Gastroenterology. 2008;134(5):1570–1595. 3- Centers fo rDisease Control and Prevention. Vitalsigns: Colorecta lcancer screening, incidence, and mortality–United States, 2002-2010. MorbMortalWklyRep. 2011; 60(26):884-889. 4- Menees SB, Elliott E, Govani S, et al. Adherence to recommended intervals for surveillance colonoscopy in average-risk patientswith 1 to 2 small (<1 cm) polyps on screeningcolonoscopy. GastrointestEndosc. 2014;79(4):551–557. 5- Lieberman DA, Rex DK, Winawer SJ et al. Guidelines for colonoscopy surveillance after screening and polypectomy: A consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2012; 143: 844–57. 6- Goodwin JS, Singh A, Reddy N, et al. Over use of screening colonoscopy in the Medicare population. Arch Intern Med.2011;171(15):1335–1343. 7- Kruse GR, Khan SM, Zaslavsky AM, et al..Overuse of colonoscopy for colorectal cancer screening and surveillance.J Gen InternMed. 2015 ;30(3):277-83. 8- Jemal A, Bray F, Center MM, et al. Global cancerstatistics. CA Cancer J. Clin. 2011; 61: 69–90. 9- Robertson DJ, Greenberg ER, Beach M, et al. Colorectal cancer in patients under close colonoscopic surveillance. Gastroenterology. 2005; 129(1):34–41. 10- Lieberman DA, Weiss DG, Harford WV, et al. Five-year colon surveillance after screening colonoscopy. Gastroenterology. 2007; 133(4):1077–85. 11- Pabby A, Schoen RE, Weissfeld JL, et al. Analysis of colorectal cancer occurrence during surveillance colonoscopy in the dietary Polyp Prevention Trial. Gastrointest Endosc. 2005; 61(3):385–91. 12- Farrar WD, Sawhney MS, Nelson DB, et al. Colorectal cancers found after a complete colonoscopy. Clin Gastroenterol Hepatol. 2006; 4(10):1259–64. 13- Singh H, Turner D, Xue L, et al. Risk of developing colorectal cancer following a negative colonoscopy examination: Evidence for a 10-year interval between colonoscopies. JAMA 2006; 295: 2366–73. 14- Baxter NN, Goldwasser MA, Paszat LF, et al. Association of colonoscopy and death from colorectal cancer. Ann Intern Med. 2009; 150: 1–8. 15- Brenner H, Hoffmeister M, Arndt V, et al. Protection from right- and left-sided colorectal Neoplasms afte rcolonoscopy: Population-based study. J Natl Cancer Inst. 2010; 102: 89–95. 16- Singh H, Nugent Z, Demers AA, et al. The reduction in colorectal cancer mortality after Colonoscopy varies by site of the cancer. Gastroenterology 2010; 139: 1128–37. 17- Brenner H, Chang-Claude J, Seiler CM, et al. Protection from colorectal cancer afte rcolonoscopy: A population-based, case-controlstudy. Ann Intern Med 2011; 154: 22–30. 18- Martinez ME, Baron JA, Lieberman DA et al. A pooled analysis of advanced colorectal neoplasia diagnoses after colonoscopic polypectomy. Gastroenterology 2009; 136: 832–41.
Öz
Giriş ve Amaç: Kolonoskopik
polipektomi yapıldıktan sonra hastalar uluslararası kılavuzlarca önerilen takip
aralıklarına göre izlenir. Bu çalışmada klinik pratikte, kılavuzlarca
belirlenmiş olan takip aralıklarına uyulup uyulmadığı ve takip aralığını
kısaltmanın advanced adenomatöz polip (AAP) ve/veya kolon kanseri saptanması
üzerine önleyici etkisi olup olmadığının araştırılması amaçlanmıştır.
Gereç ve Yöntem:
Türkiye Yüksek İhtisas Eğitim ve Araştırma Hastanesi Gastroenteroloji Kliniği
Endoskopi Ünitesinde Ocak 2008-Aralık 2015 tarihleri arasında kolonoskopi
yapılan 2178 hastanın verileri retrospektif olarak incelendi. İlk kolonoskopideadenom
saptanan olgular, kılavuzların belirttiğinden daha erken takip kolonoskopisi
yapılan (Grup A) ve kılavuzların önerdiği sürede takip kolonoskopisi yapılanlar
(Grup B) şeklinde 2 gruba ayrılarak AAP ve kanser varlığı açısından karşılaştırıldı.
Bulgular: Çalışmaya başlangıç kolonoskopi esnasında yaş
ortalaması 56,8 olan 270 olgu dahil edildi. Bu hastaların ilk kolonoskopisinde
759 polip, 582 adenom ve 95 AAP tespit edildi. Klinik uygulamamızda ilk
kolonoskopi ile ikinci kolonoskopi arası ortanca süre 21 aydı. Olguların 228
(%84,1)’i Grup A, 42 (%15,9)’si ise Grup B’de idi. İki grup arasında takip
kolonoskopi esnasında AAP (%6,6 vs. %11,9, p=0,2) veya kanser (%0,4 vs. %0 p=1.0) varlığı açısından
anlamlı bir fark bulunmadı.
Sonuç:İlk
kolonoskopide polip saptanan hastalara kılavuzlara göre belirtilen süreden daha
kısa aralıklarda takip kolonoskopi yapmanın anlamlı düzeyde ek bir faydası
gösterilememiştir.
Anahtar Kelimeler
Kaynakça
- 1- Zauber AG, Winawer SJ, O'Brien MJ, et al. Colonoscopicpolypectomyandlong-termprevention of colorectal-cancerdeaths. N Engl J Med. 2012;366(8):687–696. 2- Levin B, Lieberman DA, McFarland B, et al. Screenin g and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008:a joint guideline from the American Cancer Society, the US Multi-SocietyTask Force on Colorectal Cancer, and the American College of Radiology.Gastroenterology. 2008;134(5):1570–1595. 3- Centers fo rDisease Control and Prevention. Vitalsigns: Colorecta lcancer screening, incidence, and mortality–United States, 2002-2010. MorbMortalWklyRep. 2011; 60(26):884-889. 4- Menees SB, Elliott E, Govani S, et al. Adherence to recommended intervals for surveillance colonoscopy in average-risk patientswith 1 to 2 small (<1 cm) polyps on screeningcolonoscopy. GastrointestEndosc. 2014;79(4):551–557. 5- Lieberman DA, Rex DK, Winawer SJ et al. Guidelines for colonoscopy surveillance after screening and polypectomy: A consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2012; 143: 844–57. 6- Goodwin JS, Singh A, Reddy N, et al. Over use of screening colonoscopy in the Medicare population. Arch Intern Med.2011;171(15):1335–1343. 7- Kruse GR, Khan SM, Zaslavsky AM, et al..Overuse of colonoscopy for colorectal cancer screening and surveillance.J Gen InternMed. 2015 ;30(3):277-83. 8- Jemal A, Bray F, Center MM, et al. Global cancerstatistics. CA Cancer J. Clin. 2011; 61: 69–90. 9- Robertson DJ, Greenberg ER, Beach M, et al. Colorectal cancer in patients under close colonoscopic surveillance. Gastroenterology. 2005; 129(1):34–41. 10- Lieberman DA, Weiss DG, Harford WV, et al. Five-year colon surveillance after screening colonoscopy. Gastroenterology. 2007; 133(4):1077–85. 11- Pabby A, Schoen RE, Weissfeld JL, et al. Analysis of colorectal cancer occurrence during surveillance colonoscopy in the dietary Polyp Prevention Trial. Gastrointest Endosc. 2005; 61(3):385–91. 12- Farrar WD, Sawhney MS, Nelson DB, et al. Colorectal cancers found after a complete colonoscopy. Clin Gastroenterol Hepatol. 2006; 4(10):1259–64. 13- Singh H, Turner D, Xue L, et al. Risk of developing colorectal cancer following a negative colonoscopy examination: Evidence for a 10-year interval between colonoscopies. JAMA 2006; 295: 2366–73. 14- Baxter NN, Goldwasser MA, Paszat LF, et al. Association of colonoscopy and death from colorectal cancer. Ann Intern Med. 2009; 150: 1–8. 15- Brenner H, Hoffmeister M, Arndt V, et al. Protection from right- and left-sided colorectal Neoplasms afte rcolonoscopy: Population-based study. J Natl Cancer Inst. 2010; 102: 89–95. 16- Singh H, Nugent Z, Demers AA, et al. The reduction in colorectal cancer mortality after Colonoscopy varies by site of the cancer. Gastroenterology 2010; 139: 1128–37. 17- Brenner H, Chang-Claude J, Seiler CM, et al. Protection from colorectal cancer afte rcolonoscopy: A population-based, case-controlstudy. Ann Intern Med 2011; 154: 22–30. 18- Martinez ME, Baron JA, Lieberman DA et al. A pooled analysis of advanced colorectal neoplasia diagnoses after colonoscopic polypectomy. Gastroenterology 2009; 136: 832–41.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Makaleler |
| Yazarlar | |
| Yayımlanma Tarihi | 29 Ağustos 2017 |
| Yayımlandığı Sayı | Yıl 2017 Cilt: 25 Sayı: 2 |