The concept of 'Semi-clean colon' using the pit pattern classification system has the potential to be acceptable in combination with a <3-year surveillance colonoscopy.
The concept of 'Semi-clean colon' using the pit pattern classification system has the potential to be acceptable in combination with a <3-year surveillance colonoscopy.
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DOI：
10.3892/ol.2017.6491
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发表时间：
2017-09
期刊：
影响因子：
2.9
通讯作者：
Ishida F
中科院分区：
文献类型：
--
作者：
Maeda Y;Kudo SE;Wakamura K;Miyachi H;Misawa M;Mori Y;Ogata N;Kudo T;Kodama K;Hisayuki T;Hayashi T;Katagiri A;Ishida F
目前，结直肠病变的组织学特征通过放大色素内窥镜检查[凹坑模式（PIT）分类]进行评估。在小型（≤5mm）腺瘤性息肉（DAP）中很少观察到高级组织学特征。日本指南指出，没有癌变的微小肿瘤病变可能不予治疗和随访。在目前的机构中，IIIL 型 PIT 的 DAP 在许多情况下都没有得到治疗，而 III、IV 或 V 型 PIT 的病变通常通过常规结肠镜检查切除。这项回顾性研究旨在使用 PIT 分类评估 DAP 的管理。该研究的参与者包括 30 年前转诊进行初次结肠镜检查，然后在手术后 3 年内重新观察的患者。参与者被分为三组：A组，未经治疗的IIIL PIT DAP患者（半清洁结肠组）； B组，切除所有肿瘤性息肉（包括DAP）的患者（清洁结肠组）； C组，无任何腺瘤性息肉的患者（内部对照组）。分析了三组随访结肠镜检查时指数病变（IL）的累积发生率。该研究共有 4,313 名患者入组，分类如下：A 组，1,246 名；A 组，1,246 名； B组1,205人；和C组，1,862名患者。 A组检测到ILs，100个（8.0%）； B组，104人（8.6%）； C组29例（1.6%）。 A 组和 B 组之间没有观察到显着差异。事实证明，去除 IIIL 型 PIT DAP 不会在 3 年时间内降低 IL 的发生率。因此，这些息肉可能不予治疗，并在适当的时间间隔内重新观察患者，可能等于息肉切除术后建议的时间间隔。
Histological features of colorectal lesions are currently evaluated via a magnifying chromoendoscopy [pit pattern (PIT) classification]. Advanced histological features are rarely observed in diminutive (≤5 mm) adenomatous polyps (DAPs). The Japanese guidelines indicate that diminutive neoplastic lesions without carcinomatous findings may be left untreated and followed up. At the present institution, DAPs with type IIIL PIT are left untreated in various cases, whereas lesions with type III, IV or V PIT are typically resected via routine colonoscopy. This retrospective study aimed to assess the management of DAPs using PIT classification. The participants of the study included patients <30 years previously referred for an initial colonoscopy, then reobserved for <3 years following the procedure. Participants were classified into three groups: Group A, Patients with type IIIL PIT DAP left untreated (semi-clean colon group); group B, patients with all neoplastic polyps, including DAPs, resected (clean colon group); and group C, patients without any adenomatous polyps (internal control group). The cumulative incidence of the index lesions (ILs) at the follow-up colonoscopy was analysed among the three groups. A total of 4,313 patients were enrolled in the study, with categorization as follows: Group A, 1,246; group B, 1,205; and group C, 1,862 patients. ILs were detected in group A, 100 (8.0%); group B, 104 (8.6%); and group C, 29 (1.6%) patients. There was no significant difference observed between groups A and B. It was verified that removing the type IIIL PIT DAPs did not decrease the incidence of ILs within a 3-year time period. Therefore, these polyps may be left untreated in combination with patient reobservation at an appropriate time interval, potentially one equal to that suggested following a polypectomy.
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