Division of Gastroenterology, Department of Internal Medicine, Chungnam National University Sejong Hospital, Chungnam National University School of Medicine, Daejeon, Republic of Korea.
Division of Gastroenterology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Republic of Korea.
Dig Dis. 2022;40(5):545-552. doi: 10.1159/000520829. Epub 2021 Nov 11.
Colonoscopy surveillance guidelines set the surveillance schedule based on polyp characteristics. Polyps with high-grade dysplasia (HGD) require 3 years of follow-up regardless of size. However, it is unclear whether patients with diminutive polyps (≤5 mm) with HGD have a higher risk. We evaluated the effect of diminutive adenoma with HGD on adenoma occurrence.
From January 2015 to December 2017, patients who underwent index and surveillance colonoscopy were retrospectively screened. The patients were grouped into no adenoma group, low-risk (patients with ≤2 low-grade dysplasia [LGD]), diminutive HGD, and high-risk (HGD >5 mm, ≥3 adenomas) groups according to the index colonoscopy results. Each group was analyzed using logistic analysis.
The mean follow-up period was 22.47 months. Altogether, 610 (50.45%) patients had LGD and 152 (12.5%) had HGD. Among them, 61 (5.0%) patients had a diminutive polyp with HGD. Analysis of the risks of developing advanced adenoma in the surveillance colonoscopy showed that compared to the no adenoma group, the diminutive HGD group did not show a significant risk (odds ratio [OR] = 1.503 [0.449-5.027], p = 0.509), while the high-risk group showed a significant risk (OR = 2.044 [1.015-4.114], p = 0.045).
Diminutive adenoma with HGD increased the risk of adenoma on surveillance colonoscopy, and in the case of advanced adenoma, the risk was increased, but it was not statistically significant.
结肠镜检查监测指南根据息肉特征制定监测计划。高级别异型增生（HGD）的息肉无论大小均需 3 年随访。然而，目前尚不清楚是否存在 HGD 微小息肉（≤5mm）的患者风险更高。我们评估了伴有 HGD 的微小腺瘤对腺瘤发生的影响。
回顾性筛选 2015 年 1 月至 2017 年 12 月期间行首次及随访结肠镜检查的患者。根据首次结肠镜检查结果，将患者分为无腺瘤组、低危组（患者存在≤2 个低级别异型增生[LGD]）、微小 HGD 组和高危组（HGD＞5mm，≥3 个腺瘤）。采用 logistic 分析对各组进行分析。
平均随访时间为 22.47 个月。共 610（50.45%）例患者存在 LGD，152（12.5%）例患者存在 HGD。其中，61（5.0%）例患者存在 HGD 微小息肉。在监测结肠镜检查中进展为高级别腺瘤的风险分析中，与无腺瘤组相比，微小 HGD 组无显著风险（比值比[OR] = 1.503[0.449-5.027]，p = 0.509），而高危组显示出显著风险（OR = 2.044[1.015-4.114]，p = 0.045）。
伴有 HGD 的微小腺瘤增加了监测结肠镜检查中腺瘤的风险，而在存在高级别腺瘤的情况下，风险增加，但无统计学意义。
