Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA.
Department of Gastroenterology, Rush University Medical Center, Chicago, Illinois, USA.
Gastrointest Endosc. 2018 Jun;87(6):1518-1526. doi: 10.1016/j.gie.2017.12.028. Epub 2018 Jan 11.
The association of proximal small and diminutive hyperplastic polyps (HPs) with synchronous advanced neoplasia is not well-defined. However, sessile serrated polyps (SSPs), even when small, are known to portend a risk of synchronous neoplasia. Currently, the U.S. Multi-Society Task Force on Colorectal Cancer does not recommend a change in the surveillance interval when proximal small HPs are detected. We aimed to compare the rates of synchronous advanced neoplasia in a screening colonoscopy cohort of patients with small and then diminutive proximal HPs in comparison, first to a cohort absent any serrated or proximal HPs and then in comparison with a cohort with small proximal SSPs.
Consecutive screening colonoscopies were recorded between 2005 and 2010 at an academic medical center. Patients were divided into 3 mutually exclusive groups. Group 1 consisted of patients with at least 1 HP that was proximal to the sigmoid colon, <1 cm in endoscopic size, and up to 3 total HPs in number. Group 2 included patients without any proximal HPs or SSPs. Group 3 consisted of patients with 1 to 2 SSPs, with at least 1 being proximal to the sigmoid colon, that were <1 cm in endoscopic size and without dysplasia. Rates of synchronous advanced neoplasia in patients with small (<1 cm) and diminutive (≤5 mm) proximal HPs were compared with the rates for the other 2 groups.
There were 482 of 2569 patients (18.8%) with a small proximal HP who met the criteria for Group 1. The rate of synchronous advanced neoplasia in patients with a small proximal HP (61/482, 12.7%) was significantly greater compared with the average risk in the non-serrated cohort (Group 2, 133/1878, 7.1%; P < .001). There was no significant difference in the rate of synchronous advanced neoplasia when the small proximal HP group was subdivided by size (≤5 mm, 51/404, 12.6% vs 6-9 mm, 10/78, 12.8%; P = 1.00). The rate of synchronous advanced neoplasia in patients with diminutive (≤5 mm) proximal HPs (51/404, 12.6%) was not significantly different from the rate observed with proximal SSPs of similar size (17/113, 15.0%; P = .529).
Patients with small and diminutive proximal HPs tend to harbor higher rates of synchronous advanced neoplasia compared with those without any serrated lesions detected on screening colonoscopy. Surveillance outcomes for metachronous advanced neoplasia for patients with small proximal HPs deserves further study. The synchronous advanced neoplasia rate in patients with proximal diminutive HPs is similar to that of proximal diminutive SSPs and could have implications in a resect and discard strategy.
近端小且微小增生性息肉（HP）与同步高级别肿瘤的关联尚未明确。然而，已知即使是无蒂锯齿状息肉（SSP），即使较小，也预示着同步发生肿瘤的风险。目前，美国多学会大肠癌工作组不建议当检测到近端小 HP 时改变监测间隔。我们旨在比较在筛查性结肠镜检查队列中，小的和微小的近端 HP 患者的同步高级别肿瘤的发生率，首先与无锯齿状或近端 HP 的队列进行比较，然后与小的近端 SSP 队列进行比较。
连续记录了 2005 年至 2010 年在一家学术医疗中心进行的筛查性结肠镜检查。患者被分为 3 个互斥组。第 1 组由至少有 1 个位于乙状结肠近端、内镜大小<1cm、总数不超过 3 个的 HP 患者组成。第 2 组包括无任何近端 HP 或 SSP 的患者。第 3 组由至少有 1 个位于乙状结肠近端、内镜大小<1cm 且无发育不良的 1 至 2 个 SSP 患者组成。比较小（<1cm）和微小（≤5mm）近端 HP 患者的同步高级别肿瘤发生率与其他 2 组的发生率。
在 2569 名患者中，有 482 名（18.8%）符合第 1 组标准的小的近端 HP。小的近端 HP 患者（61/482，12.7%）的同步高级别肿瘤发生率明显高于无锯齿状病变队列（第 2 组，133/1878，7.1%；P<.001）。当根据大小（≤5mm，51/404，12.6% vs 6-9mm，10/78，12.8%；P=1.00）对小的近端 HP 组进行细分时，同步高级别肿瘤的发生率没有显著差异。微小（≤5mm）近端 HP 患者（51/404，12.6%）的同步高级别肿瘤发生率与类似大小的近端 SSP 患者（17/113，15.0%；P=0.529）无显著差异。
与筛查结肠镜检查中未发现任何锯齿状病变的患者相比，小的和微小的近端 HP 患者往往具有更高的同步高级别肿瘤发生率。需要进一步研究小的近端 HP 患者的同步高级别肿瘤的随访结果。小的近端微小 HP 患者的同步高级别肿瘤发生率与小的近端 SSP 相似，这可能对切除和丢弃策略有影响。
