Gastroenterology Department, Rabin Medical Center, Petah Tikva, Israel.
Department of Internal Medicine D, Beilinson Hospital, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Gastrointest Endosc. 2017 Oct;86(4):713-721.e2. doi: 10.1016/j.gie.2017.02.034. Epub 2017 Mar 8.
The current guidelines for surveillance after polypectomy do not distinguish between diminutive (1-5 mm) and small (6-9 mm) polyps with low-grade dysplasia (LGD). We aimed to evaluate the risk for advanced neoplasia on follow-up colonoscopy.
We retrospectively analyzed 443 patients whose worst finding at index colonoscopy was polypectomy of 1 to 5 or 6 to 9 mm polyps with LGD and those who underwent a follow-up colonoscopy.
During a mean follow-up of 32.0 months (interquartile range 13-48 months), advanced neoplasia was found in 26 patients (5.9%). Among all included patients (n = 443), advanced neoplasia was found in 13 of 310 patients (4.2%) of the 1- to 5-mm group versus 13 of 133 patients (9.8%) of the 6- to 9-mm group (hazard ratio [HR], 3.49; 95% confidence interval [CI], 1.6-7.6). Among the patients with 1 to 2 polyps resected (n = 313), advanced neoplasia was found in 8 of 231 patients (3.5%) of the 1- to 5-mm group versus 8 of 82 patients (9.8%) of the 6- to 9-mm group (HR 3.97; 95% CI, 1.47-10.7). Among the patients with ≥3 polyps resected (n = 130), advanced neoplasia was found in 5 of 79 patients (6.3%) of the 1- to 5-mm group versus 5 of 51 patients (9.8%) of the 6- to 9-mm group (HR 2.4; 95% CI, 0.7-8.36). Fair bowel preparation also was associated with the risk for advanced neoplasia at follow-up (HR 3.87, 95% CI, 1.70-8.82).
Our findings suggest that among patients with up to 9-mm adenomatous polyps, a polyp size of 6 to 9 mm, >2 polyps, and fair bowel preparation are associated with advanced neoplasia.
目前的息肉切除术后监测指南并未区分低级别异型增生（LGD）的 1-5 毫米和 6-9 毫米小息肉。我们旨在评估随访结肠镜检查时进展性肿瘤的风险。
我们回顾性分析了 443 名患者，其索引结肠镜检查的最差发现是切除 1-5 毫米或 6-9 毫米的 LGD 息肉，且这些患者接受了随访结肠镜检查。
在平均 32.0 个月（13-48 个月的四分位间距）的随访期间，26 名患者（5.9%）发现了高级别肿瘤。在所有纳入的患者（n=443）中，1-5 毫米组的 310 名患者中有 13 名（4.2%）和 6-9 毫米组的 133 名患者中有 13 名（9.8%）发现了高级别肿瘤（风险比[HR]，3.49；95%置信区间[CI]，1.6-7.6）。在切除 1-2 个息肉的患者中（n=313），1-5 毫米组的 231 名患者中有 8 名（3.5%）和 6-9 毫米组的 82 名患者中有 8 名（9.8%）发现了高级别肿瘤（HR 3.97；95% CI，1.47-10.7）。在切除≥3 个息肉的患者中（n=130），1-5 毫米组的 79 名患者中有 5 名（6.3%）和 6-9 毫米组的 51 名患者中有 5 名（9.8%）发现了高级别肿瘤（HR 2.4；95% CI，0.7-8.36）。肠道准备不佳也与随访时高级别肿瘤的风险相关（HR 3.87，95% CI，1.70-8.82）。
我们的研究结果表明，在直径最大 9 毫米的腺瘤性息肉患者中，息肉大小为 6-9 毫米、息肉数量多于 2 个和肠道准备不佳与高级别肿瘤相关。
