Long-term Follow Up After Colonoscopy Screening And Polypectomy Of501Cases Of The Middle-aged And The Aged Male Health Care Population

Background: Through the China’s rapid development of social economy, theprevalence and mortality of colorectal cancer (CRC)has increased significantly inrecent years. More than1.2million new CRC cases a year were diagnosed and morethan0.75million died of CRC each year. The prevalence in middle-aged and elderlypopulation was higher. Studies have shown that over85%of CRC originate fromadenomatous polyps and the carcinogenesis process reserves about10years, so themorbidity and mortality could be reduced effectively by screening, early detecting andearly removing the adenomatous polyps or CRC. Most of the developed countries inAmerican and European countries have made guidelines for colorectal cancerscreening and surveillance based on the carcinogenesis process from adenomatouspolyps to CRC and promote the guidelines in the crowed. Statistics showed both themorbidity and mortality in American and European countries were in a decreasetrend,especially substantially decreased among the people older than65in themedicare population(from2008to2010, the people older than65in the United Statesexperienced average annual falls in CRC morbidity of7.2%). Colonoscopy hasbecome the main screening tools for seeing the lesions of colorectal mucosa, obtainingthe biopsy and treatment. There are many differences in different guidelines and theratio of people who get the colonoscopy is very low, even in American it is less than20%. There are some issues about the screening process: the colonoscopy quality wasspotty and the surveillance did not follow the guidelines strictly. In2011,the expertsmade Chinese Consensus on Screening， Early Diagnosis， Early Therapy， andPrevention for Colorectal Cancer and Adenoma. As china has entered the aging society,it is very important to screen and monitor in the elderly by colonoscopy. However, westill don’t know the trends of the colorectal polyps of the middle-aged and the aged male health care population during a long-term colonoscopy follow-up.Objective: To analyze the trends of the number, the size, the pathological features andthe anatomic sites of colorectal polyps of the middle-aged and the aged male healthcare population during a long-term colonoscopy follow-up study.Methods：Endoscopic reports and pathological reports of the middle-aged and the agedmale health care patients, who underwent colonoscopy from April1983to April2013and followed up at least5years, were retrospectively reviewed, and the general data ofpatients were collected. The proportion of different histological types, the distributionat different anatomic sites, and the trends of the size and the number of colorectalpolyp in different follow up years were analyzed.Results：1、A total of3746colonoscopy reports of501cases of the middle-aged and the agedhealth care population were collected. After the initial colonoscopy screening andpolypectomy, there are501cases,371cases,251cases and106cases followed up tothe5th,10th,15th and20th years. The patients were between50—99years ofage(mean age （74±9） years). And the mean age of the initial colonoscopy screeningand polypectomy was66±8years, then followed-up between54~348months. In thefollow-up process each patient had（7±5） colonoscopies performed. A total of9006polys were detected and3986polyps were confirmed pathologically and65.44%of thepolyps were adenomas.4638(51.50%) polyps were located in descending colon andrectum, while1314(14.60%) were located in ascending colon and cecum.2、Of the population, the size of colorectal polyps was different and in descendingtrend（the sizes of the initial colonoscopy,the5th year, the tenth year,the fifteenth yearand the twentieth year during the follow up period were0.44±0.03，0.07±0.01，0.07±0.01，0.12±0.03，0.07±0.01；all P＜0.05），also the number was different duringfollow-up years and in descending trend compared with the initial colonoscopy（thenumbers of the initial colonoscopy,the5th year, the10th year,the15th year and the20h year during the follow up period were3.08±0.19，0.77±0.09，0.83±0.10，1.84±0.29，1.03±0.20；all P＜0.05）； 3、The number of four different pathological types of polyps were all in a descendingtrend compared with the initial colonoscopy, and the peaks of number were obtainedaround2ed,5th,7th,10th~11th,15th and18th~19th year of follow up. There werestatistically differences between tubular adenoma and tubule-villous adenoma,inflammatory polyps and hyperplastic polyps in the mean number at the samefollow-up year（all P＜0.05）.4、The number of colorectal polyps in different anatomic sites was different in the samefollow-up year（all P＜0.05）.Conclusions：The mean age of the initial colonoscopy screening and polypectomy was(66±8) years. The main histological type of colorectal polyps was adenoma. Rectum,sigmoid and descending colon are the major sites of colorectal polyps. In the follow-upprocess the size and the number of colorectal polyps were both in a descending trendand the number had a change with years. The recurrence of colorectal polyps duringfollow-up years had pathological and anatomical disparities.