Resolution of severe Clostridium difficile infection following sequential fecal microbiota transplantation.
Resolution of severe Clostridium difficile infection following sequential fecal microbiota transplantation.
复制标题
连续粪便微生物移植后严重艰难梭菌感染的解决。
DOI：
10.1097/mcg.0b013e31829004ae
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发表时间：
2013
影响因子：
2.9
通讯作者：
Khoruts,Alexander
中科院分区：
文献类型：
--
作者：
Weingarden,AlexaR;Hamilton,MatthewJ;Sadowsky,MichaelJ;Khoruts,Alexander
几项研究表明，这些病变在内窥镜下的表现很微妙，切除这些病变，特别是无蒂锯齿状腺瘤/息肉，对内窥镜医生来说是一项挑战，在结肠镜检查期间有30%的病变未完全切除。12，13此外，大的近端锯齿状息肉患者在结肠镜检查时可能同时出现腺瘤，12，14，15可能导致更高的癌症累积风险。一些研究表明，约8%至35%的晚期腺瘤，即高危腺瘤，可能在大约10年内进展为结直肠癌。16，17我们发现18例近端大锯齿状息肉患者中有3例（17%）在相同解剖位置发生结直肠癌。然而，尚不清楚该随访期是否足够长以澄清锯齿状息肉的自然史，因为Lash等人18提出，与传统腺瘤-癌序列相比，无蒂锯齿状腺瘤/息肉发展为结直肠癌的时间跨度更长。鉴于高风险腺瘤和大近端锯齿状息肉的进展之间可能存在相似性，将大近端锯齿状息肉视为需要完全切除和监测的高风险锯齿状病变似乎是合理的，与美国结直肠癌多学会工作组指南中最近提出的高风险腺瘤相似。6在我们的研究中，近端锯齿状息肉的相对较小的尺寸被认为已经进展为结直肠癌，这表明使用6 mm的截止值来定义大的锯齿状息肉可能会确保它们的检测和完全切除。在这些病例中，我们报告了3例大的近端锯齿状息肉，在结肠镜检查时未完全切除，这可能解释了结肠镜检查后癌症的发生。这些数据表明，提高认识和适当的切除技术是重要的，以最大限度地发挥结肠镜检查在近端结肠的保护作用。
Several studies indicate that these lesions have a subtle endoscopic appearance and removal, in particular of sessile serrated adenomas/polyps, is challenging for endoscopists, with 30% being incompletely removed during colonoscopy. 12, 13 In addition, patients with large proximal serrated polyps are likely to have synchronous adenomas during colonoscopy, 12, 14, 15 perhaps leading to a higher cumulative risk for developing cancer.Some studies indicate that about 8% to 35% of all advanced adenomas, that is, high-risk adenomas, might progress to colorectal cancer within approximately 10 years. 16, 17 We found that 3 out of 18 (17%) patients with large proximal serrated polyps developed colorectal cancer at the same anatomic location. It is, however, unclear whether this follow-up period was long enough to clarify the natural history of the serrated polyps, as Lash et al18 suggested a longer time span for the development of colorectal cancer from sessile serrated adenomas/polyps than the conventional adenoma-carcinoma sequence. Given the possible similarities between progression of highrisk adenomas and large proximal serrated polyps, it seems reasonable to consider large proximal serrated polyps as high-risk serrated lesions requiring complete removal and surveillance, similarly to high-risk adenomas, as recently proposed in the US Multi-Society Task Force on Colorectal Cancer guidelines. 6 The relatively small size of proximal serrated polyps, which were deemed to have progressed to colorectal cancer in our study, suggest that using a cut-off value of 6mm in defining large serrated polyps might secure both their detection and complete resection. In these series, we report on 3 cases of large proximal serrated polyps, incompletely removed at the time of colonoscopy, which might have explained the occurrence of postcolonoscopy cancers. These data indicate that improved awareness and adequate resection techniques are important to maximize the protective effect of colonoscopy in the proximal colon.