Different prevalence of colorectal polyp between the patients who underwent endoscopic resection for gastric dysplasia or early gastric cancer and normal healthy subjects

초록

Background Endoscopic mucosal resection (EMR) or endoscopic sub-mucosal dissection (ESD) is popular therapeutic modality for gastric dysplasia or early gastric cancer (EGC), but definite strategy for screening colonofiberscopy among these patients is not settled yet. We aimed in this study to compare the prevalence of colorectal polyp or adenocarcinoma between patients who underwent EMR or ESD for gastric dysplasia or EGC and normal healthy subjects. Methods We reviewed medical records in Korea University Guro Hospital from January 2002 to October 2008. We enrolled the patients who had EMR or ESD for gastric dysplasia or EGC and total colonofiberscopy for screening of colorectal polyp in ESD group, and the subjects who had upper esophagogastroscopy and total colonofiberscopy for general health work up and were matched in age and sex of ESD group for control group. We defined the high risk polyp if one of the followings was satisfied: 1) polyp number ≥3 2) polyp size ≥1.0 cm or 3) confirmed high-grade dysplasia (HGD) or adenocarcinoma by pathologic finding.Results 186 patients were enrolled in each group (male : female 145:41, mean age 63.0 ± 8.6 years). There were no significant differences in body mass index, diabetes, hypertension, or current infection rate of Helicobacter pylori between two groups. Among total 372 patients, overall colorectal polyp was detected in 124 (33.3%), high risk polyp in 44 (11.8%) and adenocarcinoma in 10 (2.7%). The prevalence of overall polyp and high risk polyp was significantly higher in ESD group than control group (40.9% vs. 25.8%, P = 0.002 and 15.6% vs. 8.1%, P = 0.025, respectively). This different pattern of prevalence was also noticed when selecting the patients among ESD group who underwent procedure for gastric HGD or adenocarcinoma and comparing with age- and sex-matched control group (overall polyp: 37.9% vs. 25.8%, P = 0.034, high risk polyp: 17.4% vs. 7.6%, P = 0.016). Furthermore, the patients in ESD group had risk for overall and high risk colorectal polyp more than 2 times comparing with subjects in control group by multivariate analysis (OR: 2.141, 95% CI: 1.353–3.388, P = 0.001 and OR: 2.214, 95% CI: 1.094–4.124, P = 0.026, respectively). Conclusion Clinicians should consider screening colonofiberscopy more actively among the patients who had EMR or ESD for gastric dysplasia or EGC to detect colorectal dysplastic or cancerous lesions.