Sanford R. Weiss M.D. Center for Hereditary Colorectal Neoplasia, Cleveland Clinic Foundation, Cleveland, Ohio.
Dis Colon Rectum. 2021 Jul 1;64(7):e391-e394. doi: 10.1097/DCR.0000000000002030.
When patients with familial adenomatous polyposis have a severely affected rectum, it is usually assumed that endoscopic control is impossible or unwise. The standard approach is proctectomy with either an end ileostomy or an IPAA. Here we show that application of aggressive, multistage snare polypectomy to this situation can be effective and allow the patient to avoid surgery, at least in the short term.
Standard polypectomy using snare excision with coagulation is used, taking 2 or 3 sessions, and beginning with the largest polyps. The procedures are performed with the patient under general anesthesia. Endoscopic mucosal resection technique with fluid injection to lift polyps is not necessary.
Complete control of the rectal polyps, sustained for at least 2 years, is possible without functional sequelas.
Patients with familial adenomatous polyposis with severe rectal polyposis can be offered multistage rectal polypectomy and safely avoid proctectomy.
当家族性腺瘤性息肉病患者的直肠严重受累时，通常认为内镜控制是不可能或不明智的。标准方法是进行直肠切除术，要么行末端回肠造口术，要么行 IPAA。在此，我们表明，对这种情况进行积极的多阶段圈套息肉切除术可能是有效的，并使患者至少在短期内避免手术。
采用圈套切除术联合电凝术进行标准息肉切除术，进行 2 或 3 次，从最大的息肉开始。这些程序在全身麻醉下进行。不需要使用内镜黏膜切除术技术进行注液抬举息肉。
至少 2 年的持续完全控制直肠息肉，无功能后遗症。
严重直肠息肉病的家族性腺瘤性息肉病患者可接受多阶段直肠息肉切除术，并安全避免直肠切除术。
