Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
Department of Surgical Pathology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Dig Dis Sci. 2022 Jul;67(7):3192-3199. doi: 10.1007/s10620-021-07292-9. Epub 2021 Nov 3.
Recurrence after cold snare polypectomy (CSP) sometimes occurs. We assessed the feasibility of repeat CSP for recurrence after CSP.
We retrospectively reviewed recurrent lesions after CSP which were resected by repeat CSP from 2016 to 2021 in our institution and analyzed clinical outcomes of repeat CSP, comparing those of non-recurrent 454 lesions receiving standard CSP in 2016 and follow-up colonoscopy. We also analyzed the recurrent rate among cases receiving follow-up in both groups. Indication of repeat CSP was lesions diagnosed as benign tumors of ≤ 10 mm.
We analyzed 80 lesions receiving repeat CSP. The polyp size (mean ± standard deviation: SD) was 4.1 ± 2.3 mm (range 2-10 mm). The right-sided colon and non-polypoid morphology rates were 66.3% and 43.8%, respectively. Histopathological diagnosis was 66 adenomas, 12 sessile serrated lesions (SSLs), 1 SSL with dysplasia, and 1 high-grade dysplasia. The procedure time (min, mean ± SD) of repeat CSP was 0.9 ± 0.8. Regarding the comparison of repeat CSP/ standard CSP group, the en bloc resection and histopathological complete resection rates were 78.8%/ 98.0% (p < 0.001) and 43.8%/59.6% (p = 0.007) and the rates of perioperative hemorrhage requiring endoscopic clipping were 1.3%/ 1.0% (p = 0.646). There were no postoperative hemorrhage and perforation in both groups (p = 1.0). Among lesions receiving follow-up colonoscopy, the mean recurrence rates (number, median follow-up period: interquartile) of repeat CSP and standard CSP group were 2.0% (1/50, 12 months: 12-24) versus 0.7% (3/454, 12 months: 12-24) (p = 0.862).
Repeat CSP for benign recurrent lesions after CSP was safe and feasible.
冷圈套息肉切除术（CSP）后有时会复发。我们评估了对 CSP 后复发进行重复 CSP 的可行性。
我们回顾性分析了 2016 年至 2021 年我院对 CSP 后复发的病变进行重复 CSP 切除的患者，分析了重复 CSP 的临床结果，并比较了 2016 年接受标准 CSP 切除和随访结肠镜检查的 454 例无复发病变的结果。我们还分析了两组中接受随访的病例的复发率。重复 CSP 的适应证为诊断为良性肿瘤的病变，大小≤10mm。
我们分析了 80 例接受重复 CSP 的患者。息肉大小（平均值±标准差：SD）为 4.1±2.3mm（范围 2-10mm）。右侧结肠和非息肉样形态的比例分别为 66.3%和 43.8%。组织病理学诊断为 66 例腺瘤、12 例无蒂锯齿状病变（SSLs）、1 例 SSL 伴异型增生和 1 例高级别异型增生。重复 CSP 的手术时间（min，平均值±SD）为 0.9±0.8。关于重复 CSP/标准 CSP 组的比较，整块切除和组织学完全切除率分别为 78.8%/98.0%（p<0.001）和 43.8%/59.6%（p=0.007），围手术期需要内镜夹闭止血的比例分别为 1.3%/1.0%（p=0.646）。两组均无术后出血和穿孔（p=1.0）。在接受随访结肠镜检查的病变中，重复 CSP 和标准 CSP 组的平均复发率（例数，中位数随访时间：四分位间距）分别为 2.0%（1/50，12 个月：12-24）和 0.7%（3/454，12 个月：12-24）（p=0.862）。
对 CSP 后良性复发性病变进行重复 CSP 是安全可行的。
