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Gaitada gizli kan testi pozitifliği nedeni ile kolonoskopi yapılan hastaların kolonoskopik ve patolojik sonuçlarının değerlendirilmesi

Yıl 2018, Cilt: 17 Sayı: 1, 17 - 20, 24.04.2018
https://doi.org/10.17941/agd.431639

Öz

Giriş ve Amaç: Kolorektal kanser taramasında gaitada gizli kan testi dışında, fekal immünokimyasal test, fleksible sigmoidoskopi ve kolonoskopi kullanılan diğer yöntemlerdir. Bu çalışmada gaitada gizli kan testi pozitif olması nedeni ile kolonoskopi istenmiş olan hastaların kolonoskopik ve patolojik bulgularını değerlendirmeyi amaçladık. Gereç ve Yöntem: Bu çalışmaya Haziran 2014-Ekim 2016 yılları arasında gaitada gizli kan testi pozitif saptanan ve kolonoskopi yapılması için Ahi Evran Üniversitesi Eğitim ve Araştırma Hastanesi endoskopi ünitesine yönlendirilen hastalar alındı. Yetersiz kolon temizliği, aktif hematokezyası, kolon operasyonu öyküsü, inflamatuvar barsak hastalığı öyküsü veya üst gastrointestinal sistem endoskopisinde kanamaya neden olabilecek lezyonu olan hastalar çalışma dışı bırakıldı. Hastaların yaşları, cinsiyetleri, kolonoskopik bulguları, patoloji sonuçları not edildi. Üç ya da daha fazla polip, 1 cm’den büyük adenomatöz polip, patolojik incelemede villöz komponent içeren ya da yüksek dereceli displazi saptanan hastalar yüksek riskli grup olarak değerlendirildi ve bu kriterlere göre kolon kansertarama programına alındı. Bulgular: Çalışmaya toplam 225 hasta dâhil edildi. Hastaların 111’i (%49.3) erkek, 114’ü (%50.7) kadın, ortalama yaşları 58.52 (24-90), ortalama hemoglobin düzeyi 13.63 (7.2-18) idi. Endoskopik tanıları; normal kolonoskopik bulgular 86 (%38,2), polip 59 (%26,2) , yalnızca perianal hastalık 27 (%12), divertikül 16 (%7,1), kolon kanseri 14 (%6,2), inflamatuvar barsak hastalığı 14 (%6,2), enfeksiyöz kolit 6 (%2,7), anjiodisplazi 3 (%1,3) hasta şeklinde idi. Endoskopik olarak kolon kanseri düşünülen ve polip saptanan 73 (%32,4) hastanın patoloji sonuçları; tübüler adenom 31 (%42,5), adenokarsinom 17 (%23,3), hiperplastik polip 16 (%21,9), tübülovillöz adenom 7 (%9,6), serrated adenom 2 (%2,7) şeklinde değerlendirildi. Kolonoskopik olarak polip saptanan 3 (%5,08) hastanın patolojisinde erken evre karsinom saptandı. Polip saptanan 59 hastanın 30’u (%50,8) yüksek riskli, 29’u (%49,2) düşük riskli olarak bulundu. Sonuç: Gaitada gizli kan testi pozitifliği ile gelen hastaların yaklaşık yarısında kolon patolojisi tespit edilmiştir. Bu test, kolon kanseri ve öncül lezyonlarının tespitinde olduğu gibi, subklinik inflamatuvar barsak hastalığı, kronik kan kaybına yol açan divertikül, anjiodisplazi gibi patolojilerin de tespitinde yardımcı olan ucuz, kolay uygulanabilir bir yöntemdir.

Kaynakça

  • 1. Maida M, Macaluso FS, Ianiro G, et al. Screening of colorectal cancer: present and future. Expert Rev Anticancer Ther 2017;17:1131- 46.
  • 2. Issa IA, Noureddine M. Colorectal cancer screening: An updated review of the available options. World J Gastroenterol 2017;23:5086- 96.
  • 3. Lieberman DA. Clinical practice. Screening for colorectal cancer. N Engl J Med 2009;361:1179-87.
  • 4. Bond JH. Fecal occult blood tests in occult gastrointestinal bleeding. Semin Gastrointest Dis 1999;10:48-52.
  • 5. Allison JE. Review article: faecal occult blood testing for colorectal cancer. Aliment Pharmacol Ther 1998;12:1-10.
  • 6. Yang H, Ge Z, Dai J, et al. Effectiveness of the immunofecal occult blood test for colorectal cancer screening in a large population. Dig Dis Sci 2011;56:203-7.
  • 7. Mandel JS, Bond JH, Church TR, et al. Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study. N Engl J Med 1993;328:1365-71.
  • 8. Hardcastle JD, Justin TA. Screening high-risk groups for colorectal neoplasia. Am J Gastroenterol 1996;91:850-2.
  • 9. Kronborg O, Fenger C, Olsen J, et al. Randomised study of screening for colorectal cancer with faecal-occult-blood test. Lancet 1996;348:1467-71.
  • 10. Bjerrum A, Andersen O, Fischer A, et al. Long-term risk of colorectal cancer after negative colonoscopy in a Danish gFOBT screening cohort. Int J Cancer 2017;141:503-11.
  • 11. Paimela H, Malila N, Palva T, Hakulinen T, Vertio H, Jarvinen H. Early detection of colorectal cancer with faecal occult blood test screening. Br J Surg 2010;97:1567-71.
  • 12. Brenner H, Hoffmeister M, Birkner B, Stock C. Men with negative results of guaiac-based fecal occult blood test have higher prevalences of colorectal neoplasms than women with positive results. Int J Cancer 2014;134:2927-34.
  • 13. IJspeert JEG, Bevan R, Senore C, et al. Detection rate of serrated polyps and serrated polyposis syndrome in colorectal cancer screening cohorts: a European overview. Gut 2017;66:1225-32.
  • 14. Steele RJ, McClements PL, Libby G, et al. Results from the first three rounds of the Scottish demonstration pilot of FOBT screening for colorectal cancer. Gut 2009;58:530-5.

Evaluation of colonoscopic and pathological outcomes of patients who have undergone colonoscopy with a positive fecal occult blood screening test

Yıl 2018, Cilt: 17 Sayı: 1, 17 - 20, 24.04.2018
https://doi.org/10.17941/agd.431639

Öz

Background and Aims: Methods such as guaiac fecal occult blood-screening test, fecal immunological test, colonoscopy, and sigmoidoscopy are generally used in colorectal screening programs. The aim of this study was to evaluate the colonoscopic and pathological findings of patients with a g-fecal occult blood-screening test-positive result. Materials and Methods: This study was conducted between June 2014 and October 2016 on patients who were referred to Ahi Evran University Training and Research Hospital endoscopy unit after a positive stool blood test and then 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 the upper gastrointestinal system. Age, sex, and colonoscopic and pathological findings of the study participants were recorded. Patients with three or more polyps, an adenomatous polyp measuring >1 cm in diameter, pathological examination involving the villous component, or high-grade dysplasia were evaluated as the high-risk group. These patients attended the colon cancer screening program. Results: A total of 225 patients, including 111 (49.3%) males, were recruited in the study. The mean age was 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 who were diagnosed with colon cancer and polyps through endoscopy wereas follows: tubular adenoma [31 patients (42.5%)], adenocarcinoma [17 patients (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 59 patients who were diagnosed with polyps, 30 (50.8%) patients were at high risk and 29 (49.2%) were at low risk. Conclusion: Colonic pathology was detected in about half of the patients positive for g-fecal occult blood-screening test. This test is not only an inexpensive and easily applicable method for colon cancer screening, but it is also helpful for the detection of pathologies that could lead to chronic blood loss, such as subclinical inflammatory bowel disease, diverticulitis, and angiodysplasia.

Kaynakça

  • 1. Maida M, Macaluso FS, Ianiro G, et al. Screening of colorectal cancer: present and future. Expert Rev Anticancer Ther 2017;17:1131- 46.
  • 2. Issa IA, Noureddine M. Colorectal cancer screening: An updated review of the available options. World J Gastroenterol 2017;23:5086- 96.
  • 3. Lieberman DA. Clinical practice. Screening for colorectal cancer. N Engl J Med 2009;361:1179-87.
  • 4. Bond JH. Fecal occult blood tests in occult gastrointestinal bleeding. Semin Gastrointest Dis 1999;10:48-52.
  • 5. Allison JE. Review article: faecal occult blood testing for colorectal cancer. Aliment Pharmacol Ther 1998;12:1-10.
  • 6. Yang H, Ge Z, Dai J, et al. Effectiveness of the immunofecal occult blood test for colorectal cancer screening in a large population. Dig Dis Sci 2011;56:203-7.
  • 7. Mandel JS, Bond JH, Church TR, et al. Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study. N Engl J Med 1993;328:1365-71.
  • 8. Hardcastle JD, Justin TA. Screening high-risk groups for colorectal neoplasia. Am J Gastroenterol 1996;91:850-2.
  • 9. Kronborg O, Fenger C, Olsen J, et al. Randomised study of screening for colorectal cancer with faecal-occult-blood test. Lancet 1996;348:1467-71.
  • 10. Bjerrum A, Andersen O, Fischer A, et al. Long-term risk of colorectal cancer after negative colonoscopy in a Danish gFOBT screening cohort. Int J Cancer 2017;141:503-11.
  • 11. Paimela H, Malila N, Palva T, Hakulinen T, Vertio H, Jarvinen H. Early detection of colorectal cancer with faecal occult blood test screening. Br J Surg 2010;97:1567-71.
  • 12. Brenner H, Hoffmeister M, Birkner B, Stock C. Men with negative results of guaiac-based fecal occult blood test have higher prevalences of colorectal neoplasms than women with positive results. Int J Cancer 2014;134:2927-34.
  • 13. IJspeert JEG, Bevan R, Senore C, et al. Detection rate of serrated polyps and serrated polyposis syndrome in colorectal cancer screening cohorts: a European overview. Gut 2017;66:1225-32.
  • 14. Steele RJ, McClements PL, Libby G, et al. Results from the first three rounds of the Scottish demonstration pilot of FOBT screening for colorectal cancer. Gut 2009;58:530-5.
Toplam 14 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Makaleler
Yazarlar

Özlem Gül Utku Bu kişi benim

Bilal Ergül

Dilek Oğuz

Yayımlanma Tarihi 24 Nisan 2018
Yayımlandığı Sayı Yıl 2018 Cilt: 17 Sayı: 1

Kaynak Göster

APA Utku, Ö. G., Ergül, B., & Oğuz, D. (2018). Gaitada gizli kan testi pozitifliği nedeni ile kolonoskopi yapılan hastaların kolonoskopik ve patolojik sonuçlarının değerlendirilmesi. Akademik Gastroenteroloji Dergisi, 17(1), 17-20. https://doi.org/10.17941/agd.431639

test-5