Cohort study for colorectal diminutive adenomatous polyps

在这项纵向研究中，我们评估了在后续结肠镜检查中发现的晚期肿瘤的发生率，这些患者在最初的结肠镜检查中发现了小（< 5mm）的腺瘤性息肉，但没有进行切除。晚期肿瘤被定义为大于10毫米的低级别不典型增生，腺瘤伴有高级别不典型增生成分，或癌。在中位时间间隔61个月的随访结肠镜检查中，713例患者中有20例（2.8%;95% CI 1.6 - 4.0）发现晚期肿瘤。只有1例晚期肿瘤患者需要手术治疗，其余19例患者均通过内镜切除治愈。即使小的腺瘤性息肉在筛查时未得到治疗，晚期瘤变的风险也没有增加。我们的非转诊策略被认为是可以接受的，只要这些患者接受推荐的后续结肠镜检查。

In this longitudinal study, we assess the incidence of advanced neoplasia detected during follow-up colonoscopies in patients who were found to have diminutive (<5 mm) adenomatous polyps during initial screening colonoscopies but were not referred for removal. Advanced neoplasia was defined as low-grade dysplasia more than 10 mm, adenoma with a high-grade dysplasia component, or carcinoma. Advanced neoplasia was detected in 20 (2.8%; 95% CI 1.6 to 4.0) of 713 such patients during follow-up colonoscopies over a median interval of 61 months. Only one patient with advanced neoplasia needed surgical treatment, however, such lesions in remaining 19 patients were curatively treated by endoscopic resection. Risk of advanced neoplasia was not increased even when diminutive adenomatous polyps had been untreated at screening. Our non-referral strategy was considered to be acceptable, provided such patients undergo recommended follow-up colonoscopies.