经器械辅助肠镜检查（DAE）治疗后息肉病综合征患者的手术风险：长期随访
Risk for Surgery in Patients with Polyposis Syndrome after Therapy by Device-Assisted Enteroscopy (DAE): Long-Term Follow Up.
作者信息
Marmo Clelia, Tortora Annalisa, Costamagna Guido, Nicolò Rebecca, Riccioni Maria Elena
机构信息
UOC Endoscopia Digestiva Chirurgica, Fondazione Policlinico Universitario A Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
UOC Gastroenterologia e Medicina Interna, Fondazione Policlinico Universitario A Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
出版信息
J Clin Med. 2022 Feb 9;11(4):899. doi: 10.3390/jcm11040899.
BACKGROUND AND AIM OF THE STUDY
Polyposis syndromes such as Peutz-Jeghers (PJ) and familial adenomatous polyposis (FAP) are associated with the growth of small bowel polyps; the risk is approximately 60-90% for PJ and 40-70% for FAP. The primary aim of this study was to evaluate the efficacy of device-assisted enteroscopy (DAE) in the detection and treatment of small bowel polyps to reduce the risk of surgery. The secondary objective was to study complications and mortality.
METHODS
We conducted a retrospective cohort study by analyzing a structured database. Between September 2006 and October 2019, we observed and followed 42 consecutive patients with polyposis syndromes; they underwent device-assisted enteroscopy and three were excluded from elective surgery after the exam. The endoscopic exams were performed for diagnostic and therapeutic purposes.
RESULTS
Thirty-nine patients were evaluated with a mean follow up of 6.7 years (±SD 2.7), 79.5% were female with a mean age of 43.8 years (±SD 15.02), and 68 enteroscopies were performed with the removal of 64 polypoid lesions. One bleeding episode occurred after operative enteroscopy, and the need for subsequent surgery occurred in six patients with PJ and in five patients with FAP. The surgical indications in PJ patients were the presence of large polyps (three patients) and three cases of intussusception, one of which was a patient with a polyp in the proximal ileum, not reachable with the scope. One patient with PJ died from pancreatic cancer during follow up. The surgical indications in patients with FAP were the presence of four large polyps with high-grade dysplasia and one ampullary neoplasia recurrence.
CONCLUSIONS
In PJ patients, the endoscopic treatment of small bowel polyps was safe. During the follow-up period, the patients with successful endoscopic treatment did not need surgery. In FAP patients treated with DAE, none developed cancer.
研究背景与目的
诸如黑斑息肉病（PJ）和家族性腺瘤性息肉病（FAP）等息肉病综合征与小肠息肉的生长相关；PJ患者发生小肠息肉的风险约为60 - 90%，FAP患者为40 - 70%。本研究的主要目的是评估器械辅助小肠镜检查（DAE）在检测和治疗小肠息肉以降低手术风险方面的疗效。次要目标是研究并发症和死亡率。
方法
我们通过分析结构化数据库进行了一项回顾性队列研究。在2006年9月至2019年10月期间，我们观察并随访了42例连续的息肉病综合征患者；他们接受了器械辅助小肠镜检查，其中3例在检查后被排除在择期手术之外。内镜检查用于诊断和治疗目的。
结果
对39例患者进行了评估，平均随访6.7年（标准差±2.7），79.5%为女性，平均年龄43.8岁（标准差±15.02），共进行了68次小肠镜检查，切除了64个息肉样病变。手术小肠镜检查后发生了1次出血事件，6例PJ患者和5例FAP患者需要进行后续手术。PJ患者的手术指征为存在大息肉（3例患者）和3例肠套叠，其中1例是回肠近端有息肉的患者，内镜无法到达。1例PJ患者在随访期间死于胰腺癌。FAP患者的手术指征为存在4个伴有高级别异型增生的大息肉和1例壶腹肿瘤复发。
结论
在PJ患者中，小肠息肉的内镜治疗是安全的。在随访期间，内镜治疗成功的患者无需手术。在接受DAE治疗的FAP患者中，无一例发生癌症。
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