Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, United States.
Endoscopy. 2023 Jun;55(6):537-543. doi: 10.1055/a-1976-4757. Epub 2022 Nov 10.
Large (≥ 20 mm) nonpedunculated colorectal lesions have high rates of synchronous neoplasia and advanced neoplasia. Synchronous neoplasia prevalence in patients with large pedunculated lesions is uncertain. We describe synchronous neoplasia in patients with large pedunculated colorectal polyps, using a cohort of patients with large nonpedunculated lesions as controls.
This study was a retrospective assessment of a prospectively recorded database listing synchronous findings in patients with ≥ 20 mm colorectal lesions referred to a tertiary center for endoscopic resection.
At least one synchronous precancerous lesion was identified in 66/78 patients with large pedunculated index lesions (84.6 %, 95 %CI 74.9-91.1) and 726/814 patients with large nonpedunculated index lesions (89.2 %, 95 %CI 87.1-91.3). Patients with a large pedunculated index lesion had mean of 4.8 synchronous conventional adenomas, 56.4 % had ≥ 1 synchronous high risk lesion (advanced adenoma or advanced serrated lesion), 48.7 % had ≥ 1 synchronous advanced conventional adenoma, and 19.2 % had a synchronous neoplastic lesion ≥ 20 mm. Compared with patients with nonpedunculated index lesions, patients with large pedunculated index lesions had comparable rates of synchronous polyps, adenomas, and sessile serrated lesions, and higher rates of synchronous adenomas with villous elements (15.6 % [95 %CI 13.3-18.3] vs. 26.9 % [95 %CI 18.3-37.7]; = 0.01) and synchronous pedunculated polyps (9.5 % [95 %CI 7.6-11.7] vs. 33.3 % [95 %CI 23.8-44.4]; < 0.001).
In patients with large (≥ 20 mm) pedunculated colorectal lesions, rates of synchronous neoplasia and advanced synchronous neoplasia were high and comparable to or higher than rates of synchronous neoplasia in patients with large nonpedunculated colorectal lesions.
大（≥20mm）无蒂结直肠病变的同时性肿瘤和高级别肿瘤发生率较高。有蒂大病变患者的同时性肿瘤患病率尚不确定。我们描述了大的有蒂结直肠息肉患者的同时性肿瘤，使用了一组无蒂大病变患者作为对照。
本研究是对一个前瞻性记录的数据库进行回顾性评估，该数据库列出了三级中心行内镜下切除的≥20mm 结直肠病变患者的同时性发现。
在 78 例大的有蒂指数病变患者（84.6%，95%CI 74.9-91.1）中，至少发现一个癌前病变，在 814 例大的无蒂指数病变患者（89.2%，95%CI 87.1-91.3）中，至少发现一个癌前病变。大的有蒂指数病变患者平均有 4.8 个同时性常规腺瘤，56.4%有≥1 个同时性高危病变（高级别腺瘤或高级别锯齿状病变），48.7%有≥1 个同时性高级别常规腺瘤，19.2%有≥20mm 的同时性肿瘤性病变。与无蒂指数病变患者相比，有蒂指数病变患者的同时性息肉、腺瘤和无蒂锯齿状病变发生率相似，而有蒂腺瘤伴绒毛成分的发生率更高（15.6%[95%CI 13.3-18.3]比 26.9%[95%CI 18.3-37.7]；=0.01）和同时性有蒂息肉（9.5%[95%CI 7.6-11.7]比 33.3%[95%CI 23.8-44.4]；<0.001）。
在大（≥20mm）有蒂结直肠病变患者中，同时性肿瘤和高级别同时性肿瘤的发生率较高，与大的无蒂结直肠病变患者的同时性肿瘤发生率相当或更高。
