Introduction:Performing a tandem endoscopy and colonoscopy in selected individuals has advantages, such as the early detection of benign and/or precancerous foregut diseases; it is efficient, and it may allow added therapies. It may also have disadvantages, such as generating anxiety from false-positive screening, possible harm from further testing, and unproven cost-effectiveness.Aims:We aimed to examine the prevalence of foregut endoscopic and histologic abnormalities in subjects referred for screening/surveillance colonoscopy who also underwent a tandem endoscopy. We wanted to (1) assess implications for cancer detection, intervention, and surveillance of precancerous foregut abnormalities, (2) identify benign foregut lesions, and (3) generate data on the utilities of this tandem approach.Patients and Methods:A retrospective cohort study of consecutive subjects referred for screening or surveillance colonoscopy who also underwent an endoscopy. Based on national screening guidelines, responses to prompting questions, personal or family history, or other risk factors, subjects were assigned to tandem endoscopy with biopsies (modified Seattle and Sydney protocols), under one anesthesia.Results:Of the 1004 patients referred for colonoscopy, 317 (32%) underwent tandem endoscopy. There were 214 women and 103 men. There were 237 Whites, 16 Asians, 40 Blacks, and 24 Hispanics. Median age was 59 (range 19–85). At endoscopy, we identified actionable benign (45%) peptic, inflammatory, andH. pylori-related abnormalities, and premalignant findings (i.e., intestinal metaplasia, 27%, dysplasia, 2%, and cancer 0.9%), comparable to the premalignant (40.3%) and malignant (0.6%) colonoscopy yield.Conclusions:When implemented based on national screening guidelines, tandem EGD and colonoscopy combines Barrett’s esophagus and gastric cancer screening in one examination, and it has a high yield in a diverse US population.
引言：对特定个体实施串联式内镜与结肠镜检查具有诸多优势，例如可早期发现良性和/或癌前性上消化道疾病；该方案效率较高，并可能提供额外的治疗机会。但同时也存在潜在弊端，包括假阳性筛查可能引发焦虑、进一步检查可能造成伤害，以及成本效益尚未得到充分验证。 目的：本研究旨在探讨接受筛查/监测性结肠镜检查并同期接受串联式内镜检查的受试者中，上消化道内镜及组织学异常的患病率。我们期望：（1）评估该方案对癌前性上消化道异常的癌症检出、干预及监测意义；（2）识别良性上消化道病变；（3）生成关于该串联式检查方案实用性的数据。 患者与方法：本研究为回顾性队列研究，纳入连续接受筛查或监测性结肠镜检查并同期接受内镜检查的受试者。根据国家筛查指南、提示性问题反馈、个人或家族病史及其他风险因素，受试者在单次麻醉下接受包含活检（改良西雅图与悉尼方案）的串联式内镜检查。 结果：在1004名接受结肠镜检查的患者中，317名（32%）接受了串联式内镜检查。其中女性214名，男性103名；白种人237名，亚裔16名，非裔40名，西班牙裔24名。中位年龄59岁（范围19-85岁）。内镜检查发现需干预的良性病变（45%），包括消化性、炎症性及幽门螺杆菌相关异常；同时检出癌前病变（肠上皮化生27%、异型增生2%）及恶性肿瘤（0.9%）。该癌前病变检出率（40.3%）与恶性肿瘤检出率（0.6%）与结肠镜检查结果具有可比性。 结论：基于国家筛查指南实施的串联式上消化道内镜与结肠镜检查，可在单次检查中同步完成巴雷特食管与胃癌筛查，在美国多元化人群中具有较高的病变检出率。
肿瘤(癌症)患者之家