VALUTAZIONE DELL'UTILITA DEL CLEAN COLON NEL FOLLOW-UP DEI PAZIENTI SOTTOPOSTI A POLIPECTOMIA ENDOSCOPICA

The appropriate surveillance times in patients with colorectal polyps removed endoscopically are not known. Many authors recommend repeating the colonoscopy after 1 year to detect the polyps missed on the index colonoscopy (CI). Aim of this study is to evaluate the usefulness of this procedure to prevent colorectal cancer in adenoma subjects. Two hundred and seventy two patients had a colonoscopic polypectomy between 1980-1989 in our Endoscopy Service. One hundred and sixty six of them (61%) underwent a colonoscopic examination one year later the CI. Fifty polyps were removed in thirty two of these subjects (19%) (mean size 4.3 mm, range 2-10 mm); the size distribution of adenomas showed that 44 (88%) were small (<6 mm) and 6 (12%) medium (6-10 mm). None of these adenomas could be considered 'missed' at CI. Three years after the CI, 83/166 (50%) patients that had had the colonoscopic examination one year after the CI (Group A) and 37/106 (34.9%) patients that declined the examination one year after the CI (Group B) underwent a new colonoscopic examination. Fifteen out of eighty three patients (18.1%) of group A and eight out of thirty seven patients (21.6%) of group B showed new polyps (chi-square test, P = 0.68). All these adenomas showed mild to moderate dysplasia, but one (in a group A patient) showed severe dysplasia. The results of this study suggest that the endoscopic examination one year after the index colonoscopy is not useful to reduce the risk of cancer in patients with colorectal adenomas.