Digestive Health Institute, University of California, Irvine Medical Center, Orange, CA.
Gastroenterology Division, Eastern VA Medical School, Norfolk, VA.
J Clin Gastroenterol. 2021 Oct 1;55(9):733-739. doi: 10.1097/MCG.0000000000001594.
Leaving no significant polyp behind while avoiding risks due to unnecessary resections is a commonsense strategy to safely and effectively prevent colorectal cancer (CRC) with colonoscopy. It also alludes to polyps worth removing and, therefore, worth finding. The majority of "worthy" precancerous polyps are adenomas, which for over 2 decades, have received the most attention in performance research and metrics. Consequently, the detection rate of adenomas is currently the only validated, outcome-based measure of colonoscopy demonstrated to correlate with reduced risk of postcolonoscopy CRC. However, a third or more of postcolonoscopy CRCs originate from sessile serrated polyps (SSPs), which are notoriously difficult to find, diagnose and completely resect. Among serrated polyps, the agreement among pathologists differentiating SSPs from non-neoplastic hyperplastic polyps is moderate at best. This lack of ground truth precludes SSPs from consideration in primary metrics of colonoscopy quality or performance of novel polyp detection technologies. By instead leveraging the distinct endoscopic and clinical features of serrated polyps, including those considered important due to proximal location and larger size, clinically significant serrated polyps represent serrated polyps worth removing, enriched with subtle precancerous SSPs. With the explosion of technologies to assist polyp detection, now is the time to broaden benchmarks to include clinically significant serrated polypss alongside adenomas, a measure that is relevant both for assessing the performance of endoscopists, and for assessing new polyp detection technologies.
在避免因不必要的切除而带来风险的同时，尽量切除所有显著息肉，这是一种安全有效的结肠镜结直肠癌预防策略。它还暗示了值得切除的息肉，因此值得寻找。大多数“有价值”的癌前息肉是腺瘤，腺瘤在 20 多年来一直是性能研究和指标中最受关注的对象。因此，腺瘤的检出率是目前唯一经过验证的、基于结果的结肠镜检查指标，与降低结直肠癌后风险相关。然而，三分之一或更多的结直肠癌起源于无蒂锯齿状息肉（SSP），这些息肉很难发现、诊断和完全切除。在锯齿状息肉中，病理学家区分 SSP 和非肿瘤性增生性息肉的一致性充其量只是中等。由于缺乏真实情况，SSP 无法被纳入结肠镜质量的主要指标或新型息肉检测技术的性能评估中。相反，利用锯齿状息肉的独特内镜和临床特征，包括由于位置靠近近端和尺寸较大而被认为重要的特征，有临床意义的锯齿状息肉代表了有价值的需要切除的锯齿状息肉，其中富含微妙的癌前 SSP。随着辅助息肉检测技术的爆发，现在是时候将基准扩大到包括临床意义上的锯齿状息肉和腺瘤，这一措施不仅与评估内镜医生的表现有关，而且与评估新的息肉检测技术有关。
