臨牀消化器内科 Vol.33 No.8(13)


特集名 大腸腫瘍治療後のサーベイランス
題名 正常大腸者のサーベイランス
発刊年月 2018年 07月
著者 木村 聖路 青森労災病院消化器内科内視鏡科
【 要旨 】 大腸内視鏡検査において腺腫や癌などの腫瘍性病変のない正常大腸者は,通常はサーベイランスの対象とはならないが,欧米ではそのような対象者の経過観察における大腸癌の発生率もよく検討されている.米国のガイドラインでは10年後の再検査を推奨しているが,必ずしもそれを支持する報告のみではなく,5年後までは安全とする報告も見受けられる.また初回正常大腸所見の後で内視鏡診断される浸潤癌(interval cancer,中間期癌)の例もまれながら存在しており,正常大腸者のなかには見逃された病変も隠れている可能性は否定できない.とくに検診陽性者における正常大腸者では,その後の経過観察には注意が必要である.
Theme Surveillance after Treatment for Colorectal Tumors
Title Appropriate Surveillance among Subjects Diagnosed as Having Negative Colonoscopies
Author Seiji Kimura Division of Gastroenterology and Endoscopy, Aomori Rousai Hospital
[ Summary ] Persons without detected polyps during initial colonoscopy are defined as having negative colonoscopies. In the US guidelines, they are recommended a ten year interval for repeated colonoscopies after initial negative examinations. In the Japanese literature there is no data as to the surveillance of subjects undergoing negative colonoscopy as a baseline. Although there are several reports which support the recommended ten year interval for follow-up colonoscopy for those with negative colonoscopies as a baseline, other reports support more intensive follow-ups than the recommended intervals. Another problem is the risk of interval colorectal cancer after previous negative colonoscopy. Despite a very low incidence of interval cancer after negative colonoscopy lesions may occur in patients for whom no lesions were observed during initial colonoscopy. Special attention is needed for those with positive fecal occult blood samples and negative results during subsequent colonoscopies.
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