Department of Medicine, Sorlandet Hospital Kristiansand, Kristiansand, Norway.
Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway.
Endoscopy. 2021 Apr;53(4):383-391. doi: 10.1055/a-1243-0379. Epub 2020 Sep 22.
Endoscopic screening with polypectomy has been shown to reduce colorectal cancer incidence in randomized trials. Incomplete polyp removal and subsequent development of post-colonoscopy cancers may attenuate the effect of screening. This study aimed to quantify the extent of incomplete polyp removal.
We included patients aged 50-75 years with nonpedunculated polyps ≥ 5 mm removed during colonoscopy at four hospitals in Norway. To evaluate completeness of polyp removal, biopsies from the resection margins were obtained after polypectomy. Logistic regression models were fitted to identify factors explaining incomplete resection.
246 patients with 339 polyps underwent polypectomy between January 2015 and June 2017. A total of 12 polyps were excluded due to biopsy electrocautery damage, and 327 polyps in 246 patients (mean age 67 years [range 42-83]; 52 % male) were included in the analysis. Overall, 54 polyps (15.9 %) in 54 patients were incompletely resected. Histological diagnosis of the polyp (sessile serrated lesions vs. adenoma, odds ratio [OR] 10.9, 95 % confidence interval [CI] 3.9-30.1) and polyp location (proximal vs. distal colon, OR 2.8, 95 %CI 1.0-7.7) were independent risk factors for incomplete removal of polyps 5-19 mm. Board-certified endoscopists were not associated with lower rates of incomplete resection compared with trainees (14.0 % vs. 14.2 %), OR 1.0 (95 %CI 0.5-2.1).
Incomplete polyp resection was frequent after polypectomy in routine clinical practice. Serrated histology and proximal location were independent risk factors for incomplete resection. The performance of board-certified gastroenterologists was not superior to that of trainees.
随机试验表明，内镜筛查并息肉切除术可降低结直肠癌的发病率。息肉切除不完全和随后出现的结肠镜检查后癌症可能会削弱筛查效果。本研究旨在量化息肉切除不完全的程度。
我们纳入了在挪威四家医院接受内镜检查时切除的非带蒂息肉≥5mm 的年龄在 50-75 岁之间的患者。为了评估息肉切除的完整性，在息肉切除后从切除边缘获取活检。使用逻辑回归模型来确定解释不完全切除的因素。
2015 年 1 月至 2017 年 6 月期间，246 例患者共 339 枚息肉接受了息肉切除术。共有 12 枚息肉因活检电灼损伤而被排除，246 例患者的 327 枚息肉（平均年龄 67 岁[范围 42-83]；52%为男性）纳入分析。总体而言，54 例患者的 54 枚息肉（15.9%）切除不完全。息肉的组织学诊断（锯齿状病变与腺瘤，比值比[OR]10.9，95%置信区间[CI]3.9-30.1）和息肉位置（近端与远端结肠，OR 2.8，95%CI 1.0-7.7）是 5-19mm 息肉切除不完全的独立危险因素。与受训者相比，经董事会认证的内镜医生与较低的不完全切除率无关（14.0%比 14.2%），OR 1.0（95%CI 0.5-2.1）。
在常规临床实践中，息肉切除后息肉切除不完全的情况很常见。锯齿状组织学和近端位置是切除不完全的独立危险因素。经董事会认证的胃肠病学家的表现并不优于受训者。
