Department of Colorectal Surgery, Digestive Diseases Institute, Cleveland Clinic Foundation, Desk A 30, 9500 Euclid Ave., Cleveland, OH 44195, USA.
Surg Endosc. 2013 May;27(5):1622-7. doi: 10.1007/s00464-012-2640-6. Epub 2012 Dec 13.
Serrated polyps of the large bowel are potentially premalignant, difficult to see, but important to remove. Few studies describe the technique or outcomes of serrated polypectomy. We sought to present outcomes of a series of polypectomies of large serrated polyps in comparison to a series of endoscopic resections of large adenomas.
This retrospective, comparative, single endoscopist study was performed in an outpatient colonoscopy department of a tertiary referral medical center. Patients had outpatient colonoscopy where a large (≥2 cm) serrated polyp or adenoma was removed. Outcomes were completeness of excision and complications of polypectomy. A database of endoscopic polypectomies was reviewed. Polypectomy of large serrated polyps was compared with polypectomy of large adenomas.
There were 132 large serrated polyps in 112 patients and 563 adenomas in 428 patients. More serrated polyps were right sided (120 of 130, 92.3 %, vs. 379 of 563, 67 %) (p < 0.0001). The serrated polyps were smaller than the adenomas (mean 25.5 ± 7.9 mm standard deviation) versus 36.8 ± 16.9 mm standard deviation (p < 0.001). There were four complications of serrated polypectomy in four patients (4 % of polyps, 5 % of patients): three postpolypectomy bleeds and one postpolypectomy syndrome. There were 33 complications of adenoma removal (31 postpolypectomy bleeding and two postpolypectomy syndrome) (6.9 % of polyps, p = 0.376, 8.4 % of patients, p = 0.371). On follow-up, 36 of 51 patients (71 %) with serrated polyps had metachronous lesions compared to 133 of 298 patients (45 %) with adenomas (p < 0.0001). There were fewer residual polyps in the serrated group (4 of 47 vs. 64 of 298, p = 0.001).
Removal of large serrated colorectal polyps is no more complicated than polypectomy of similarly sized adenomas. However, large serrated polyps have a higher rate of metachronous polyps than similarly sized adenomas and surveillance should be adapted to reflect these findings.
大肠锯齿状息肉具有潜在的癌前性，难以发现，但需要切除。很少有研究描述锯齿状息肉切除术的技术或结果。我们旨在介绍一系列大肠锯齿状大息肉切除术的结果，并与一系列大肠大型腺瘤内镜切除术进行比较。
本研究为回顾性、对照性、单内镜医师研究，在一家三级转诊医疗中心的门诊结肠镜检查科进行。患者接受门诊结肠镜检查，切除直径≥2 厘米的大（≥2 cm）锯齿状息肉或腺瘤。研究终点为息肉切除的完整性和息肉切除的并发症。对内镜息肉切除术数据库进行了回顾。比较了大锯齿状息肉切除术和大腺瘤切除术。
112 例患者中有 132 个大锯齿状息肉，428 例患者中有 563 个大腺瘤。更多的锯齿状息肉位于右侧（130 个中的 120 个，92.3%，而 563 个中的 379 个，67%）（p<0.0001）。锯齿状息肉比腺瘤小（平均 25.5±7.9 毫米标准差），而腺瘤为 36.8±16.9 毫米标准差（p<0.001）。4 例患者（4%的息肉，5%的患者）发生 4 例锯齿状息肉切除术后并发症（4%的息肉，5%的患者）：3 例息肉切除术后出血，1 例息肉切除术后综合征。33 例腺瘤切除术后并发症（31 例息肉切除术后出血和 2 例息肉切除术后综合征）（6.9%的息肉，p=0.376，8.4%的患者，p=0.371）。随访时，51 例锯齿状息肉患者中有 36 例（71%）出现了异时性病变，而 298 例腺瘤患者中有 133 例（45%）出现了异时性病变（p<0.0001）。锯齿状组的残留息肉较少（47 例中有 4 例，298 例中有 64 例，p=0.001）。
切除直径较大的大肠锯齿状息肉并不比切除类似大小的腺瘤更复杂。然而，大锯齿状息肉的异时性息肉发生率高于类似大小的腺瘤，监测应适应这些发现。
