Tholoor Shareef, Tsagkournis Orestis, Basford Peter, Bhandari Pradeep
Dept of Gastroenterology, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK.
Ann Gastroenterol. 2013;26(2):114-121.
There is no standardized definition of difficult polyps. However, polyps become difficult and challenging to remove endoscopically when they are large in size, flat in nature, situated in a high-risk location and when access to them is very awkward. Recently, an SMSA (Size, Morphology, Site, Access) classification has been proposed that helps to qualify the degree of difficulty by scoring on the above parameters. This article reviews the features that make polyps difficult to remove and provides some practical tips in managing these difficult polyps. We believe that 'difficult polyp' is a relative term and each endoscopist should define their own level of difficulty and what they would be able to handle safely. However, in expert trained hands, most difficult polyps can be safely removed by an endoscopic approach.
对于复杂息肉尚无标准化定义。然而，当息肉体积大、形态扁平、位于高危部位且内镜操作难以触及的时候，通过内镜切除就会变得困难且具有挑战性。最近，有人提出了一种SMSA（大小、形态、部位、可及性）分类法，该分类法通过对上述参数进行评分来帮助界定困难程度。本文回顾了导致息肉难以切除的特征，并提供了一些处理这些复杂息肉的实用技巧。我们认为，“复杂息肉”是一个相对的概念，每位内镜医师都应明确自己的困难程度标准以及能够安全处理的范围。然而，在训练有素的专家手中，大多数复杂息肉都可以通过内镜方法安全切除。
