Nisan 2018
Gaitada gizli kan testi pozitifligi nedeni ile kolonoskopi yapilan hastalarin kolonoskopik ve patolojik sonuçlarinin degerlendirilmesi
Evaluation of colonoscopic and pathological outcomes of patients who have undergone colonoscopy with a positive fecal occult blood screening test
- Ana Sayfa
- Sayılar
- Nisan 2018
- Gaitada gizli kan testi pozitifligi nedeni ile kolonoskopi yapilan hastalarin kolonoskopik ve patolojik sonuçlarinin degerlendirilmesi ...
Özet
Giris ve Amaç: Kolorektal kanser taramasinda gaitada gizli kan testidisinda, fekal immünokimyasal test, fleksible sigmoidoskopi ve kolonoskopi kullanilan diger yöntemlerdir. Bu çalismada gaitada gizli kantesti pozitif olmasi nedeni ile kolonoskopi istenmis olan hastalarin kolonoskopik ve patolojik bulgularini degerlendirmeyi amaçladik. Gereç veYöntem: Bu çalismaya Haziran 2014-Ekim 2016 yillari arasinda gaitadagizli kan testi pozitif saptanan ve kolonoskopi yapilmasi için Ahi EvranÜniversitesi Egitim ve Arastirma Hastanesi endoskopi ünitesine yönlendirilen hastalar alindi. Yetersiz kolon temizligi, aktif hematokezyasi,kolon operasyonu öyküsü, inflamatuvar barsak hastaligi öyküsü veyaüst gastrointestinal sistem endoskopisinde kanamaya neden olabileceklezyonu olan hastalar çalisma disi birakildi. Hastalarin yaslari, cinsiyetleri,kolonoskopik bulgulari, patoloji sonuçlari not edildi. Üç ya da daha fazlapolip, 1 cm’den büyük adenomatöz polip, patolojik incelemede villözkomponent içeren ya da yüksek dereceli displazi saptanan hastalar yüksek riskli grup olarak degerlendirildi ve bu kriterlere göre kolon kansertarama programina alindi. Bulgular: Çalismaya toplam 225 hasta dâhiledildi. Hastalarin 111’i (%49.3) erkek, 114’ü (%50.7) kadin, ortalamayaslari 58.52 (24-90), ortalama hemoglobin düzeyi 13.63 (7.2-18) idi.Endoskopik tanilari; normal kolonoskopik bulgular 86 (%38,2), polip 59(%26,2) , yalnizca perianal hastalik 27 (%12), divertikül 16 (%7,1), kolon kanseri 14 (%6,2), inflamatuvar barsak hastaligi 14 (%6,2), enfeksiyöz kolit 6 (%2,7), anjiodisplazi 3 (%1,3) hasta seklinde idi. Endoskopikolarak kolon kanseri düsünülen ve polip saptanan 73 (%32,4) hastaninpatoloji sonuçlari; tübüler adenom 31 (%42,5), adenokarsinom 17(%23,3), hiperplastik polip 16 (%21,9), tübülovillöz adenom 7 (%9,6),serrated adenom 2 (%2,7) seklinde degerlendirildi. Kolonoskopik olarakpolip saptanan 3 (%5,08) hastanin patolojisinde erken evre karsinomsaptandi. Polip saptanan 59 hastanin 30’u (%50,8) yüksek riskli, 29’u(%49,2) düsük riskli olarak bulundu. Sonuç: Gaitada gizli kan testipozitifligi ile gelen hastalarin yaklasik yarisinda kolon patolojisi tespitedilmistir. Bu test, kolon kanseri ve öncül lezyonlarinin tespitinde oldugu gibi, subklinik inflamatuvar barsak hastaligi, kronik kan kaybinayol açan divertikül, anjiodisplazi gibi patolojilerin de tespitinde yardimciolan ucuz, kolay uygulanabilir bir yöntemdir.
Abstract
Background and Aims: Methods such as guaiac fecal occult blood-screening test, fecal immunological test, colonoscopy, and sigmoidoscopyare generally used in colorectal screening programs. The aim of this studywas to evaluate the colonoscopic and pathological findings of patientswith a g-fecal occult blood-screening test-positive result. Materials andMethods: This study was conducted between June 2014 and October2016 on patients who were referred to Ahi Evran University Training andResearch Hospital endoscopy unit after a positive stool blood test andthen underwent colonoscopy. The exclusion criteria were inadequate colon cleansing, active hematochezia, a history of colonic surgery, inflammatory bowel disease, or any lesion that may lead to hemorrhage in theupper gastrointestinal system. Age, sex, and colonoscopic and pathological findings of the study participants were recorded. Patients with threeor more polyps, an adenomatous polyp measuring >1 cm in diameter,pathological examination involving the villous component, or high-gradedysplasia were evaluated as the high-risk group. These patients attendedthe colon cancer screening program. Results: A total of 225 patients,including 111 (49.3%) males, were recruited in the study. The mean agewas 58.52 (range: 24-90) years. Mean hemoglobin levels were 13.63(range: 7.2-18) g/dl. Endoscopic findings of these patients included normal colonoscopy [86 patients (38.2%)], polyps [59 patients (26.2%)],perianal disease [27 patients (12%)], diverticulum [16 patients (7.1%)],colon cancer [14 patients (6.2%)], inflammatory bowel disease [14 patients (6.2%)], infectious colitis [6 patients (2.7%)], and angiodysplasia[3 patients (1.3%)]. Pathological findings of 73 (32.4%) patients whowere diagnosed with colon cancer and polyps through endoscopy wereas follows: tubular adenoma [31 patients (42.5%)], adenocarcinoma [17patients (23.3%)], hyperplastic polyps [16 patients (21.9%)], tubulovillous adenoma [7 patients (9.6%)], and serrated adenoma [2 patients(2.7%)]. Early-stage carcinoma was diagnosed in the pathology of 3(5.08%) patients who had colonoscopically detected polyps. Of the 59patients who were diagnosed with polyps, 30 (50.8%) patients were athigh risk and 29 (49.2%) were at low risk. Conclusion: Colonic pathology was detected in about half of the patients positive for g-fecal occultblood-screening test. This test is not only an inexpensive and easily applicable method for colon cancer screening, but it is also helpful for thedetection of pathologies that could lead to chronic blood loss, such assubclinical inflammatory bowel disease, diverticulitis, and angiodysplasia.
