Rates of Incomplete Resection of 1-20 mm Colorectal Polyps: A Systematic Review and Meta-Analysis.
Rates of Incomplete Resection of 1-20 mm Colorectal Polyps: A Systematic Review and Meta-Analysis.
复制标题
1-20 毫米结直肠息肉不完全切除率：系统评价和荟萃分析。
作者：
R. Djinbachian;R. Iratni;Madeleine Durand;P. Marques;D. von Renteln
背景与目标
肿瘤性结直肠息肉的不完全切除可导致结肠镜检查后结直肠癌。我们进行了系统回顾和荟萃分析，以确定结直肠息肉的不完全切除率（IRR）和相关因素。
方法
我们检索了MEDLINE、EMBASE、EBM Reviews和CINAHL，以识别截至2019年3月发表的报告1-20 mm息肉IRR的全文文章。排除标准为炎症性肠病队列研究、因息肉切除困难、息肉尺寸大于20 mm和内镜下粘膜下切除术和/或剥离术作为息肉切除术方法而转诊。根据息肉切除部位的活检结果或切除息肉边缘的评估计算IRR。主要结局是圈套器切除1-20 mm息肉的IRR。次要结局包括1-10 mm和10-20 mm息肉的IRR，1-10 mm和10 -20 mm息肉的热和冷圈套器切除的IRR，圈套器切除伴或不伴粘膜下注射的IRR，以及1-5 mm息肉的钳和冷圈套器切除的IRR。
结果
在我们的定量分析中，我们确定了6148份报告，并使用了32项研究，共9282个息肉。圈套器切除1-20 mm息肉的IRR为13.8%（95% CI，10.3-17.3; 13项研究，5128例息肉切除术）。圈套器切除1-10 mm息肉的IRR为15.9%（95% CI，9.6-22.1; 9项研究，2531例息肉切除术），圈套器切除10-20 mm息肉的IRR为20.8%（95% CI，12.9-28.8; 6项研究，412例息肉切除术）。热圈套器切除1-10 mm息肉的IRR为14.2%（95% CI，5.2-23.2），冷圈套器息肉切除术的IRR为17.3%（95% CI，14.3 - 20.3）。钳子切除1-5 mm息肉的IRR为9.9%（95% CI，7.1-13.0），圈套器息肉切除术为4.4%（95% CI，2.9-6.1）。
结论
在一项系统回顾和荟萃分析中，我们发现1-20 mm的结直肠息肉经常不能完全切除，10 mm或更大的息肉风险增加。对于1-10 mm的息肉，冷圈套器与热圈套器的IRR没有差异。对于1-5 mm的息肉，圈套器息肉切除术应优于钳子息肉切除术。
BACKGROUND & AIMS
Incomplete resection of neoplastic colorectal polyps can result in post-colonoscopy colorectal cancer. We performed a systematic review and meta-analysis to determine the incomplete resection rate (IRR) of colorectal polyps and associated factors.
METHODS
We searched MEDLINE, EMBASE, EBM Reviews, and CINAHL to identify full-text articles that reported IRRs of polyps 1-20 mm, published until March 2019. Exclusion criteria were studies of inflammatory bowel disease cohorts, referrals for difficult polypectomy, polyp sizes greater than 20 mm, and endoscopic submucosal resection and/or dissection as polypectomy approaches. IRRs were calculated based on findings from biopsies taken at polypectomy sites or assessments of margins of resected polyps. The primary outcome was IRR for snare removal of polyps 1-20 mm. Secondary outcomes included IRR for polyps 1-10 mm and 10-20 mm, IRR for hot and cold snare removal of polyps 1-10 mm and 10-20 mm, IRR of snare removal with or without submucosal injection, and IRR for forceps and cold snare removal of polyps 1-5 mm.
RESULTS
We identified 6148 reports and used 32 studies, with a total of 9282 polyps, in our quantitative analysis. The IRR for snare removal of polyps 1-20 mm was 13.8% (95% CI, 10.3-17.3; 13 studies, 5128 polypectomies). IRRs were 15.9% for snare removal of polyps 1-10 mm (95% CI, 9.6-22.1; 9 studies, 2531 polypectomies) and 20.8% for snare removal of polyps 10-20 mm (95% CI, 12.9-28.8; 6 studies, 412 polypectomies). The IRR for hot snare removal of polyps 1-10 mm was 14.2% (95% CI, 5.2-23.2) vs 17.3% for cold-snare polypectomy (95% CI, 14.3‒20.3). The IRR for forceps removal of polyps 1-5 mm was 9.9% (95% CI, 7.1-13.0) vs 4.4% for snare polypectomy (95% CI, 2.9-6.1).
CONCLUSIONS
In a systematic review and meta-analysis, we found that colorectal polyps 1-20 mm are frequently incompletely resected, and that risk increases for polyps 10 mm or larger. There is no difference in IRRs of cold vs hot snares for polyps 1-10 mm. Snare polypectomy should be used over forceps for polyps 1-5 mm.
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DOI：
10.1056/nejmoa1100370
发表时间：
2012-02-23
期刊：
The New England journal of medicine
影响因子：
--
作者：
Zauber AG;Winawer SJ;O'Brien MJ;Lansdorp-Vogelaar I;van Ballegooijen M;Hankey BF;Shi W;Bond JH;Schapiro M;Panish JF;Stewart ET;Waye JD
通讯作者：
Waye JD
DOI：
10.1056/nejmoa1309086
发表时间：
2014-04-03
期刊：
The New England journal of medicine
影响因子：
--
作者：
Corley DA;Jensen CD;Marks AR;Zhao WK;Lee JK;Doubeni CA;Zauber AG;de Boer J;Fireman BH;Schottinger JE;Quinn VP;Ghai NR;Levin TR;Quesenberry CP
通讯作者：
Quesenberry CP
影响因子：
7.7
作者：
Tollivoro TA;Jensen CD;Marks AR;Zhao WK;Schottinger JE;Quinn VP;Ghai NR;Zauber AG;Doubeni CA;Levin TR;Fireman B;Quesenberry CP;Corley DA
通讯作者：
Corley DA
影响因子：
158.5
作者：
WINAWER, SJ;ZAUBER, AG;STEWART, ET
通讯作者：
STEWART, ET
影响因子：
29.4
作者：
Samadder, N. Jewel;Curtin, Karen;Burt, Randall W.
通讯作者：
Burt, Randall W.