Kim Bun, Choi A Ra, Park Soo Jung, Cheon Jae Hee, Kim Tae Il, Kim Won Ho, Hong Sung Pil
Department of Medicine, Graduate School, Yonsei University College of Medicine, Seoul, Korea.
Center for Cancer Prevention and Detection, National Cancer Center, Goyang, Korea.
Yonsei Med J. 2016 Sep;57(5):1106-14. doi: 10.3349/ymj.2016.57.5.1106.
Although there is a consensus about the need for surveillance colonoscopy after endoscopic resection, the interval remains controversial for large sessile colorectal polyps. The aim of this study was to evaluate the long-term outcome and the adequate surveillance colonoscopy interval required for sessile and flat colorectal polyps larger than 20 mm.
A total of 204 patients with large sessile and flat polyps who received endoscopic treatment from May 2005 to November 2011 in a tertiary referral center were included.
The mean age was 65.1 years and 62.7% of the patients were male. The mean follow-up duration was 44.2 months and the median tumor size was 25 mm. One hundred and ten patients (53.9%) received a short interval surveillance colonoscopy (median interval of 6.3 months with range of 1-11 months) and 94 patients (46.1%) received a long interval surveillance colonoscopy (median interval of 13.6 months with range of 12-66 months). There were 14 patients (6.9%) who had local recurrence at the surveillance colonoscopy. Using multivariate regression analysis, a polyp size greater than 40 mm was shown to be independent risk factor for local recurrence. However, piecemeal resection and surveillance colonoscopy interval did not significantly influence local recurrence.
Endoscopic treatment of large sessile colorectal polyps shows a favorable long-term outcome. Further prospective study is mandatory to define an adequate interval of surveillance colonoscopy.
尽管对于内镜切除术后进行监测性结肠镜检查的必要性已达成共识，但对于大型无蒂结直肠息肉的监测间隔仍存在争议。本研究的目的是评估直径大于20mm的无蒂和扁平结直肠息肉的长期转归以及所需的合适监测性结肠镜检查间隔。
纳入2005年5月至2011年11月在一家三级转诊中心接受内镜治疗的204例大型无蒂和扁平息肉患者。
患者的平均年龄为65.1岁，62.7%为男性。平均随访时间为44.2个月，肿瘤大小中位数为25mm。110例患者（53.9%）接受了短间隔监测性结肠镜检查（间隔中位数为6.3个月，范围为1 - 11个月），94例患者（46.1%）接受了长间隔监测性结肠镜检查（间隔中位数为13.6个月，范围为12 - 66个月）。在监测性结肠镜检查时有14例患者（6.9%）出现局部复发。通过多因素回归分析，息肉大小大于40mm被证明是局部复发的独立危险因素。然而，分块切除和监测性结肠镜检查间隔对局部复发没有显著影响。
大型无蒂结直肠息肉的内镜治疗显示出良好的长期转归。必须进行进一步的前瞻性研究以确定监测性结肠镜检查的合适间隔。
