Anderloni Andrea, Jovani Manol, Hassan Cesare, Repici Alessandro
Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy.
Clin Exp Gastroenterol. 2014 Aug 30;7:285-96. doi: 10.2147/CEG.S43084. eCollection 2014.
The major role of colonoscopy with polypectomy in reducing the incidence of and mortality from colorectal cancer has been firmly established. Yet there is cause to be uneasy. One of the most striking recent findings is that there is an alarmingly high incomplete polyp removal rate. This phenomenon, together with missed polyps during screening colonoscopy, is thought to be responsible for the majority of interval cancers. Knowledge of serrated polyps needs to broaden as well, since they are quite often missed or incompletely removed. Removal of small and diminutive polyps is almost devoid of complications. Cold snare polypectomy seems to be the best approach for these lesions, with biopsy forcep removal reserved only for the tiniest of polyps. Hot snare or hot biopsy forcep removal of these lesions is no longer recommended. Endoscopic mucosal resection and endoscopic submucosal dissection have proven to be effective in the removal of large colorectal lesions, avoiding surgery in the majority of patients, with acceptably low complication rates. Variants of these approaches, as well as new hybrid techniques, are being currently tested. In this paper, we review the current status of the different approaches in removing polypoid and nonpolypoid lesions of the colon, their complications, and future directions in the prevention of colorectal cancer.
结肠镜下息肉切除术在降低结直肠癌发病率和死亡率方面的主要作用已得到确凿证实。然而，仍有理由感到不安。最近最引人注目的发现之一是息肉切除不完全率高得惊人。这种现象，连同筛查结肠镜检查时漏诊的息肉，被认为是大多数间隔期癌症的原因。对锯齿状息肉的认识也需要拓宽，因为它们经常被漏诊或切除不完全。切除小息肉和微小息肉几乎没有并发症。冷圈套息肉切除术似乎是处理这些病变的最佳方法，活检钳切除仅保留用于最小的息肉。不再推荐用热圈套器或热活检钳切除这些病变。内镜黏膜切除术和内镜黏膜下剥离术已被证明在切除大肠大病变方面有效，大多数患者可避免手术，并发症发生率可接受且较低。目前正在测试这些方法的变体以及新的联合技术。在本文中，我们综述了结肠息肉样和非息肉样病变不同切除方法的现状、它们的并发症以及预防结直肠癌的未来方向。
