Cohort study for colorectal diminutive adenomatous polyps

在这项纵向研究中，我们评估了在初始筛查结肠镜检查中发现有微小（<5 mm）腺瘤性息肉但未被转诊切除的患者在随访结肠镜检查中发现的晚期肿瘤的发生率。晚期肿瘤定义为低度异型增生超过10 mm，腺瘤伴高度异型增生成分，或癌。在中位间隔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）检测到晚期肿瘤。只有1例晚期肿瘤患者需要手术治疗，但其余19例患者的此类病变均通过内窥镜切除术治愈。即使筛选时未治疗小型腺瘤性息肉，晚期瘤形成的风险也不会增加。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随访结肠镜检查。

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.