Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan.
Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
Int J Colorectal Dis. 2019 Sep;34(9):1563-1569. doi: 10.1007/s00384-019-03347-6. Epub 2019 Jul 16.
Incomplete polyp resection (IPR) is recognized as a risk factor for interval colorectal cancer (ICC), and is, therefore, an important issue in polypectomy. Cold snare polypectomy (CSP) is a procedure that does not involve electrocautery and has no burn effect. Therefore, there is the possibility that the risk of ICC associated with IPR is higher in cases undergoing CSP than in those undergoing hot polypectomy. However, little is known about the risk factors for IPR after CSP.
Precise identification of the risk factors can lead to prevention of IPR after CSP. Therefore, we performed this observational study for accurate identification of the risk factors for IPR after CSP.
Medical records of a total of 501 patients with 1177 colorectal polyps that were resected at Omori Red Cross Hospital between October 2017 and March 2018 were retrospectively reviewed. The lateral and deep margins of the resected polyps were evaluated to check for the resection completeness.
Among the 1177 polyp resections, 1163 were included in the final analysis. IPR was detected in 206 (17.7%) cases. Performance of the resection by a trainee (OR (95% CI) 1.87 (1.328-2.632); P < 0.001) was identified as an independent risk factor for IPR in patients undergoing CSP.
Performance of the polypectomy by a trainee was identified as a significant risk factor for IPR in patients undergoing CSP. Prospective, randomized studies are necessary in the future to develop effective methods for the prevention/control of IPR after CSP.
不完全息肉切除术（IPR）被认为是结直肠间期癌（ICC）的一个危险因素，因此是息肉切除术的一个重要问题。冷圈套息肉切除术（CSP）是一种不涉及电灼且没有灼伤效果的程序。因此，与热息肉切除术相比，行 CSP 时与 IPR 相关的 ICC 风险可能更高。然而，对于 CSP 后 IPR 的危险因素知之甚少。
准确识别危险因素可导致 CSP 后 IPR 的预防。因此，我们进行了这项观察性研究，以准确识别 CSP 后 IPR 的危险因素。
回顾性分析了 2017 年 10 月至 2018 年 3 月在大森红十字医院接受治疗的共 501 例 1177 例结直肠息肉患者的病历。评估切除息肉的侧向和深部边缘，以检查切除的完整性。
在 1177 例息肉切除中，最终有 1163 例被纳入最终分析。在 206 例（17.7%）病例中发现了 IPR。在接受 CSP 的患者中，由受训者进行的切除（OR（95%CI）1.87（1.328-2.632）；P<0.001）被确定为 IPR 的独立危险因素。
在接受 CSP 的患者中，受训者进行的息肉切除术被确定为 IPR 的显著危险因素。未来需要进行前瞻性、随机研究，以开发预防/控制 CSP 后 IPR 的有效方法。
