Advances, problems, and complications of polypectomy.
Advances, problems, and complications of polypectomy.
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DOI：
10.2147/ceg.s43084
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发表时间：
2014
影响因子：
2.4
通讯作者：
Repici A
中科院分区：
文献类型：
--
作者：
Anderloni A;Jovani M;Hassan C;Repici A
结肠镜检查和息肉切除术在降低结直肠癌发病率和死亡率方面的主要作用已经得到了明确的证实。然而，人们有理由感到不安。最近最引人注目的发现之一是，有一个令人震惊的高不完全息肉切除率。这种现象，加上筛查结肠镜检查时遗漏的息肉，被认为是大多数间隔癌症的原因。锯齿状息肉的知识也需要扩大，因为它们经常被遗漏或不完全切除。切除小的和微小的息肉几乎没有并发症。冷圈套息肉切除术似乎是治疗这些病变的最佳方法，活检钳切除术仅用于最小的息肉。不再推荐使用热圈套器或热活检钳切除这些病变。内镜下黏膜切除术和内镜下黏膜下剥离术已被证明是有效的，在大部分患者中，避免了手术，并发症发生率低，可接受的去除大的结直肠病变。目前正在测试这些方法的变体以及新的混合技术。在本文中，我们回顾了不同的方法在消除息肉和非息肉样病变的结肠，其并发症，以及未来的发展方向，在预防结直肠癌的现状。
The major role of colonoscopy with polypectomy in reducing the incidence of and mortality from colorectal cancer has been firmly established. Yet there is cause to be uneasy. One of the most striking recent findings is that there is an alarmingly high incomplete polyp removal rate. This phenomenon, together with missed polyps during screening colonoscopy, is thought to be responsible for the majority of interval cancers. Knowledge of serrated polyps needs to broaden as well, since they are quite often missed or incompletely removed. Removal of small and diminutive polyps is almost devoid of complications. Cold snare polypectomy seems to be the best approach for these lesions, with biopsy forcep removal reserved only for the tiniest of polyps. Hot snare or hot biopsy forcep removal of these lesions is no longer recommended. Endoscopic mucosal resection and endoscopic submucosal dissection have proven to be effective in the removal of large colorectal lesions, avoiding surgery in the majority of patients, with acceptably low complication rates. Variants of these approaches, as well as new hybrid techniques, are being currently tested. In this paper, we review the current status of the different approaches in removing polypoid and nonpolypoid lesions of the colon, their complications, and future directions in the prevention of colorectal cancer.