结肠镜筛查对部分老人仍有益

圣迭戈(EGMN)——根据美国一家中心对76~85岁老年人结肠镜操作的回顾结果，既往从未接受过结肠镜筛查的老年患者结直肠癌患病率很高，并且如果患者健康、身体功能良好且预期寿命不少于7年，则筛查可能有益。

 “美国预防服务工作组(USPSTF)认为，结肠镜筛查的益处要在大约7年后方可显现，如果你认为患者预期寿命不少于7年，则应进行筛查。如预期寿命不足7年，则不值得为此耗费医疗资源。”密歇根州Spectrum医学中心的Therese G. Kerwel博士说。“众所周知，USPSTF声明的标题为：对75岁以上患者无必要进行筛查。但很多人未阅读声明的详细内容，而实际上如果老年患者健康和身体功能良好，则筛查将是有利的。”对较健康的老年患者强烈考虑筛查可能获益的另一个原因为，如果患者发生结直肠癌，则急诊风险高于年轻成人，因为这类患者可能发生出血、梗阻或穿孔。总的原则是衡量风险与获益。

Kerwel博士等人对2009年1月~2010年12月期间在Spectrum医学中心接受结肠镜操作的903例76~85岁患者的数据进行了回顾。19%的操作目的纯粹为筛查，42%的操作目的为监测，35%的操作是为了探明症状原因，4%的操作目的为其他。

结果显示，在之前从未接受过结肠镜操作的53例患者(在这一亚组中，半数操作目的为筛查，半数为探明症状原因)中，结肠镜检查发现结直肠癌患病率为9%。研究组中另有56例患者在此前至少10年内未接受过结肠镜操作；在这一组患者中，5%在新的结肠镜操作中被检出肿瘤。其他88%的操作是在前一次操作后9年内进行的。最大的亚组中包含247例(占27%)在前一次操作后4~5年内再次接受检查的患者，在这一亚组中未检出任何肿瘤，这一结果提示很多老年人接受了不必要的结肠镜操作。在前一次操作后9年内接受再次检查的患者中，检出约3%患有肿瘤。

该研究结果提示，对于老年人，间隔不足10年的重复结肠镜检查的作用值得怀疑。

Kerwel医生披露无相关利益冲突。


 

SAN DIEGO (EGMN) – Elderly patients who never previously underwent screening colonoscopy have a high prevalence of colorectal cancer and could benefit from screening if they are healthy and functional and have a life expectancy of at least about 7 years, based on a review of colonoscopies done on people aged 76-85 at one U.S. center.

The results also showed a reasonable detection rate for colorectal cancers in the same age group when their prior colonoscopy had last been done 10 or more years before, Dr. Therese G. Kerwel said at the annual Digestive Disease Week meeting.

“The U.S. Preventive Services Task Force says that you don’t see benefit [from screening colonoscopy] until about 7 years so that’s the benchmark. If you think the person will live for another 7 or more years, then screen. If not, then it’s not worth the resources,” said Dr. Kerwel, a surgeon at Spectrum Health in Grand Rapids, Michigan.

“The headline from the U.S. Preventive Services Task Force is to stop screening at age 75; that’s what everyone knows. A lot of people don’t read the fine print, the loophole that you can screen elderly people if they are healthy and functional,” Dr. Kerwel said in an interview.

Another reason to strongly consider screening elderly patients who are healthy enough to potentially benefit is that if they develop colorectal cancer, they have an increased risk for an emergency presentation compared with younger adults, with the potential to develop bleeding, obstruction, or perforation, she said.

“It’s always a balance of risk and benefit, but there is definitely a subset of the elderly who need to be focused on a little more.”

The review also showed a sizeable percent of elderly people underwent colonoscopy at Spectrum Health roughly 5 years following a prior procedure, with no cases of colorectal cancer detected, indicating that a significant number of elderly people had been subjected to overly aggressive colonoscopy, Dr. Kerwel said.

She and her associates reviewed 903 people, aged 76-85 years, who underwent colonoscopy at Spectrum Health during January 2009 to December 2010. The colonoscopy occurred purely for screening in 19%, for surveillance in 42%, for symptoms in 35%, and for other reasons in 4%.

Fifty-three of the people had never previously undergone colonoscopy (in this subgroup roughly half the procedures were for screening and half were for symptoms). Colonoscopy identified colorectal carcinoma in 9%. An additional 56 people from the study group had not had a prior colonoscopy for at least 10 years; in this group the new procedure detected carcinoma in 5%.

The remaining 88% of the procedures reviewed occurred within 9 years or less of prior colonoscopy. The largest subgroup was 247 people (27% of the study group) examined 4-5 years after a prior colonoscopy. In this subgroup the procedure identified no carcinomas, and in everyone else examined 9 or fewer years after their prior examination, about 3% had cancers identified.

These results suggest that repeat colonoscopies at intervals shorter than 10 years may have questionable utility in the elderly, Dr. Kerwel said.

She said that she had no relevant financial disclosures.