Yu Lu, Li Na, Zhang Xiao Mei, Wang Tao, Chen Wei
Department of Gastroenterology, Maanshan Central Hospital, Maanshan 243000, Anhui Province, China.
Department of Gastroenterology, Affiliated Hospital of Southeast University, Nanjing 210009, Jiangsu Province, China.
World J Clin Cases. 2020 Nov 6;8(21):5180-5187. doi: 10.12998/wjcc.v8.i21.5180.
Colorectal polyps refer to all neoplasms that protrude into the intestinal cavity. Researchers believe that 50%-70% of colorectal cancers originate from adenomatous polyps.
To investigate the endoscopic morphologic features, pathologic types, and clinical situation; evaluate the efficacy and safety of endoscopic mucosal resection (EMR); and guide clinicians in their daily practice.
Two hundred thirty-four patients who underwent EMR in our hospital from January 1, 2018 to December 31, 2019 were recruited. Data including sex, age, endoscopic morphology of the polyps, and pathological characteristics were analyzed among groups.
A total of 295 polyps were resected from the 234 subjects enrolled in the study, of which 4 (1.36%) were Yamada type I. There were 75 (25.42%) type II, 101 (34.24%) type III, and 115 (38.98%) type IV adenomas. Among them, 41 were non-adenomas, 110 were low-risk adenomas, 139 were high-risk adenomas, and 5 were carcinomas. The differences in distribution were not statistically significant, with values greater than 0.05. The risk of cancer significantly increased for polyps ≥ 1 cm in diameter (c = 199.825, = 0.00). Regarding the endoscopic morphological features, congestion, erosion, and lobulation were more common on the surface morphology of high-risk adenomas and cancerous polyps (c = 75.257, = 0.00), and most of them were Yamada types III and IV. In all, 6 of the 295 polyps could not be removed completely, with a one-time resection rate of 97.97%. There were two cases of postoperative bleeding and no cases of perforation, with an overall complication rate of 0.09%.
Colorectal polyps ranging from non-adenomatous polyps, low-risk adenomas, and high-risk adenomas to adenocarcinomas each has their own endoscopic features, while EMR, as a mature intervention, has good safety and operability and should be promoted clinically, especially at the primary care level.
结直肠息肉是指所有突向肠腔的肿瘤。研究人员认为，50%-70%的结直肠癌起源于腺瘤性息肉。
探讨结直肠息肉的内镜形态学特征、病理类型及临床情况；评估内镜黏膜切除术（EMR）的疗效和安全性；并指导临床医生的日常实践。
选取2018年1月1日至2019年12月31日在我院接受EMR的234例患者。对各组患者的性别、年龄、息肉的内镜形态及病理特征等数据进行分析。
本研究纳入的234例受试者共切除295枚息肉，其中山田I型4枚（1.36%），II型75枚（25.42%），III型101枚（34.24%），IV型115枚（38.98%）。其中非腺瘤性息肉41枚，低风险腺瘤110枚，高风险腺瘤139枚，癌5枚。分布差异无统计学意义，P值大于0.05。直径≥1 cm的息肉癌变风险显著增加（c = 199.825，P = 0.00）。关于内镜形态学特征，高风险腺瘤和癌性息肉表面形态更常见充血、糜烂及分叶（c = 75.257，P = 0.00），且大多为山田III型和IV型。295枚息肉中6枚未能完全切除，一次性切除率为97.97%。术后出血2例，无穿孔病例，总体并发症发生率为0.09%。
从非腺瘤性息肉、低风险腺瘤、高风险腺瘤到腺癌的结直肠息肉各有其内镜特征，而EMR作为一种成熟的干预手段，具有良好的安全性和可操作性，应在临床上推广，尤其是在基层医疗层面。
