Clinical impact of surveillance colonoscopy using magnification without diminutive polyp removal
Clinical impact of surveillance colonoscopy using magnification without diminutive polyp removal
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DOI：
10.1111/den.12877
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发表时间：
2017-11-01
影响因子：
5.3
通讯作者：
Chayama, Kazuaki
中科院分区：
文献类型：
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作者：
Ninomiya, Yuki;Oka, Shiro;Chayama, Kazuaki
背景和目的：在西方国家，建议在结肠镜检查期间内窥镜下切除所有腺瘤。本研究评估了放大结肠镜检查的有效性，而不切除体积较小(=6 mm)、凹陷的病变和V型凹陷型病变是内窥镜切除的适应症。我们调查了监视结肠镜检查发现的需要内窥镜切除的病变的特征以及内窥镜切除的病变发生率的危险因素。结果：共有706名连续的患者入选。共检出68个病变，平均直径为9.0+/-4.8 mm，其中33个(49%)位于右半结肠。病理诊断为腺瘤58个(85%)，Tis癌8个(12%)，T1癌2个(3%)。五个病变被认为是从先前发现的微小息肉中生长出来的。首次结肠镜检查发现3个以上息肉与1个息肉的相对危险度为1.76(95%可信区间1.004~3.23)，初次结肠镜检查时发现3个以上息肉的相对危险度为3.76(95%可信区间2.03~7.5 0)，初次结肠镜检查时发现癌灶的相对危险度为2.84(95%可信区间1.43~5.24)。9例肿瘤均在内窥镜下切除。结论：放大结肠镜检查发现的微小低度腺瘤不必切除。
Background and Aim: In Western countries, endoscopic removal of all adenomas during colonoscopy is recommended. The present study evaluates the usefulness of magnifying colonoscopy without removal of diminutive (= 6 mm in size, depressed lesions, and lesions with type V pit pattern were indications for endoscopic resection. We investigated the characteristics of lesions indicated for endoscopic resection detected on surveillance colonoscopy and the risk factors for the incidence of lesions indicated for endoscopic resection.Results: A total of 706 consecutive patients were enrolled. Sixty-eight lesions indicated for endoscopic resection were detected, averaging 9.0 +/- 4.8 mm, and 33 (49%) lesions were located in the right colon. Pathological diagnoses were adenoma, Tis carcinoma, and T1 carcinoma in 58 (85%), eight (12%), and two (3%) lesions, respectively. Five lesions were considered to grow from previously detected diminutive polyps. Relative risks for the incidence of a lesion indicated for endoscopic resection were 1.76 (95% confidence interval [CI], 1.004-3.23) for males compared with females, 3.76 (95% CI, 2.03-7.50) for more than three polyps at initial colonoscopy compared with one polyp, and 2.84 (95% CI, 1.43-5.24) for patients with carcinoma at initial colonoscopy compared with patients with no lesion indicated for endoscopic resection. Nine carcinomas were resected endoscopically.Conclusion: Diminutive low-grade adenomas detected by using magnifying colonoscopy may not necessarily require removal.