Hasegawa Hiroshi, Bamba Shigeki, Takahashi Kenichiro, Murata Masaki, Otsuka Taketo, Matsumoto Hiroshi, Fujimoto Takehide, Osak Rie, Imaeda Hirotsugu, Nishida Atsushi, Ban Hiromitsu, Sonoda Ayano, Inatomi Osamu, Sasaki Masaya, Sugimoto Mitsushige, Andoh Akira
Division of Gastroenterology, Shiga University of Medical Science, Otsu, Japan.
Division of Gastroenterology, Japan Community Health Care Organization Shiga Hospital, Otsu, Japan.
Intest Res. 2019 Apr;17(2):265-272. doi: 10.5217/ir.2018.00103. Epub 2018 Nov 28.
BACKGROUND/AIMS: There are few prospective studies on cold forceps polypectomy (CFP) using jumbo cup forceps. Therefore, we examined patients with diminutive polyps (5 mm or smaller) treated with CFP using jumbo cup forceps to achieve an adenoma-free colon and also assessed the safety of the procedure and the recurrence rate of missed or residual polyp after CFP by performing follow-up colonoscopy 1 year later.
We included patients with up to 5 adenomas removed at initial colonoscopy and analyzed data from a total of 361 patients with 573 adenomas. One-year follow-up colonoscopy was performed in 165 patients, at which 251 lesions were confirmed.
The one-bite resection rate with CFP was highest for lesions 3 mm or smaller and decreased significantly with increasing lesion size. Post-procedural hemorrhage was observed in 1 of 573 lesions (0.17%). No perforation was noted. The definite recurrence rate was 0.8% (2/251 lesions). The probable recurrence rate, which was defined as recurrence in the same colorectal segment, was 17%. Adenoma-free colon was achieved in 55% of patients at initial resection. Multivariate analysis revealed that achievement of an adenoma-free colon was significantly associated with number of adenomas and years of endoscopic experience.
CFP using jumbo biopsy forceps was safe and showed a high one-bite resection rate for diminutive lesions of 3 mm or smaller. The low definite recurrence rate confirms the reliability of CFP using jumbo biopsy forceps. Number of adenomas and years of endoscopic experience were key factors in achieving an adenoma-free colon.
背景/目的：关于使用大口径杯状钳进行冷活检钳息肉切除术（CFP）的前瞻性研究较少。因此，我们对使用大口径杯状钳进行CFP治疗的微小息肉（5毫米或更小）患者进行了检查，以实现无腺瘤性结肠，并通过1年后进行随访结肠镜检查评估了该手术的安全性以及CFP术后漏诊或残留息肉的复发率。
我们纳入了在初次结肠镜检查时切除多达5个腺瘤的患者，并分析了总共361例患者573个腺瘤的数据。165例患者进行了1年的随访结肠镜检查，确认了251个病变。
CFP的一口切除率在3毫米或更小的病变中最高，并且随着病变大小的增加而显著降低。在573个病变中有1个（0.17%）观察到术后出血。未发现穿孔。明确复发率为0.8%（2/251个病变）。定义为在同一结直肠段复发的可能复发率为17%。55%的患者在初次切除时实现了无腺瘤性结肠。多变量分析显示，实现无腺瘤性结肠与腺瘤数量和内镜经验年限显著相关。
使用大活检钳的CFP是安全的，对于3毫米或更小的微小病变显示出较高的一口切除率。低明确复发率证实了使用大活检钳的CFP的可靠性。腺瘤数量和内镜经验年限是实现无腺瘤性结肠的关键因素。
