Department of Medicine, Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Gastrointest Endosc. 2017 Jan;85(1):228-233. doi: 10.1016/j.gie.2016.06.035. Epub 2016 Jun 23.
There are few data on the prevalence of synchronous colorectal lesions in patients who have large lateral spreading tumors (LLSTs). We sought to describe the rate of synchronous lesions found in patients who underwent endoscopic resection of large sessile adenomas and serrated lesions.
This is a retrospective assessment of a prospectively created database of 728 consecutive patients with resected LLSTs who underwent complete clearing of the colon during 2 colonoscopies by a single expert endoscopist.
The 728 patients with resected LLSTs and complete clearing had 4578 synchronous lesions, including 584 patients (80.2%) with at least 1 synchronous conventional adenoma, 132 (18.1%) with at least 1 synchronous conventional adenoma ≥ 20 mm in size, 294 (40.4%) with at least 1 synchronous advanced conventional adenoma, and 6 patients with a synchronous lesion with cancer. Patients with an index large sessile conventional adenoma compared with those with an index large serrated lesion had on average more synchronous conventional adenomas (4.8 vs 2.9, P = .001) and fewer synchronous serrated lesions (1.4 vs 4.5, P < .001). Of the 97 patients with a serrated class index lesion, 28 (28.9%) met criteria for serrated polyposis.
There is a very high prevalence of synchronous lesions, including other large and advanced synchronous lesions, in patients with flat or sessile conventional adenomas and serrated colorectal polyps. Patients with LLSTs in the colon need detailed clearing of the rest of the colon. Patients referred for endoscopic resection of serrated lesions ≥ 20 mm have a very high prevalence of serrated polyposis. This study has potential implications for further stratification of high-risk patient groups in postpolypectomy surveillance guidelines.
关于接受内镜下大块侧向发育型肿瘤（LLST）切除术的患者中同时存在结直肠病变的发生率，目前仅有少量数据。本研究旨在描述内镜下切除大块无蒂腺瘤和锯齿状病变患者中发现的同时性病变的发生率。
这是对 728 例接受 LLST 切除术且通过单名专家内镜医师进行 2 次结肠镜检查完成结肠完全清除的前瞻性数据库进行的回顾性评估。
728 例接受 LLST 切除术且完成结肠完全清除的患者有 4578 处同时性病变，其中 584 例（80.2%）患者至少有 1 处同时性传统腺瘤，132 例（18.1%）患者至少有 1 处同时性直径≥20mm 的传统腺瘤，294 例（40.4%）患者至少有 1 处同时性高级别传统腺瘤，6 例患者存在同时性癌症病变。与同时性锯齿状病变相比，具有指数性大型无蒂传统腺瘤的患者平均具有更多的同时性传统腺瘤（4.8 比 2.9，P=0.001）和更少的同时性锯齿状病变（1.4 比 4.5，P<0.001）。97 例锯齿状病变分类指数患者中，28 例（28.9%）符合锯齿状息肉病的标准。
具有平坦或无蒂传统腺瘤和锯齿状结直肠息肉的患者中，同时性病变的发生率非常高，包括其他大型和高级别同时性病变。结肠内存在 LLST 的患者需要详细清除其余的结肠。接受内镜下切除直径≥20mm 的锯齿状病变的患者，其锯齿状息肉病的发生率非常高。该研究可能对息肉切除术后监测指南中高危患者群体的进一步分层具有潜在意义。
