Background and Aims

For young individuals (age <40 years) without strong family histories that would put them at risk for genetic colorectal cancer syndromes, it is unclear if national Multi-Society Task Force surveillance recommendations apply or if endoscopists follow these guideline recommendations when such patients are incidentally found to have adenoma(s) on colonoscopy.

Methods

We reviewed records on young (age <40 years) patients, with either no family history or only a moderate family history (1 first-degree family member with colorectal cancer at age ≥50), who were found to have neoplastic polyp(s) on their index colonoscopy. We assessed the pattern of endoscopist surveillance recommendations, whether endoscopist recommendations complied with national guidelines, and compliance with surveillance recommendations.

Results

One hundred forty-one subjects were included, of whom 19 (13.5%) had a moderate family history of colorectal cancer. For patients with non–high-risk findings, 27.7% were asked to repeat their colonoscopy in ≤3 years and 99.0% within 5 years. Endoscopist surveillance recommendation compliance rates with national guidelines were >65.0% for low-risk neoplasia but lower for high-risk (40.0%), nonpolypoid (44.2%), and serrated neoplasia (54.2%, P < .001 for all). Subjects whose endoscopist recommendations were noncompliant with guidelines were usually recalled too early (96%). Only 24.7% of subjects were actually compliant with endoscopist surveillance recommendations.

Conclusions

For young patients with neoplastic polyp(s) but no strong family history, most endoscopists complied with national guidelines and recommended repeat colonoscopy in 3 to 5 years. However, relatively few patients were compliant with repeat colonoscopy recommendations. For most cases that were noncompliant with guidelines, patients were recalled too early as opposed to too late.

中文翻译：

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年轻散发性结直肠腺瘤患者：当前的内窥镜检查实践和结果

背景和目标

对于没有强大家族史的年轻个体（年龄<40岁），这些个体将使他们面临遗传性大肠癌综合征的风险，目前尚不清楚国家多社会工作队的监测建议是否适用，或者偶然出现的内镜医师是否遵循这些指南的建议在结肠镜检查时发现有腺瘤。

方法

我们回顾了没有家族史或仅有中等家族史（1名≥50岁的大肠癌一级家庭成员）的年轻（年龄小于40岁）患者的记录，这些患者被发现患有肿瘤性息肉。进行结肠镜检查。我们评估了内窥镜检查专家建议的模式，内窥镜检查专家的建议是否符合国家准则以及是否符合监督建议。

结果

包括一百四十一名受试者，其中19名（13.5％）有中度大肠癌家族史。对于非高危发现患者，要求≤3年重复结肠镜检查的比例为27.7％，五年内要求重复结肠镜检查的比例为99.0％。内镜医师对低危肿瘤的监测推荐符合率符合国家指导原则，> 65.0％，而高危（40.0％），非息肉样疾病（44.2％）和锯齿状瘤（54.2％， 所有P <.001）更低。内镜医师建议不符合指导原则的受试者通常被召回得太早（96％）。实际上只有24.7％的受试者符合内镜医师的监测建议。

结论

对于患有肿瘤性息肉但家族病史不长的年轻患者，大多数内镜医师均遵守国家指南并建议在3至5年内再次进行结肠镜检查。但是，很少有患者符合重复结肠镜检查的建议。对于大多数不符合指导原则的病例，患者召回得太早而不是太晚。