Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia.
Medicine, The University of Sydney Westmead Clinical School, Sydney, Australia.
Endoscopy. 2024 Feb;56(2):125-130. doi: 10.1055/a-2174-2967. Epub 2023 Sep 12.
Large (≥20mm) adenomatous anastomotic polyps (LAAPs) are uncommon. Data pertaining to their prevalence, characteristics, and the efficacy of endoscopic resection (ER) are absent. A safe and effective strategy for ER would reduce morbidity and healthcare costs.
Large nonpedunculated colorectal polyps of ≥20mm (LNPCPs) referred for ER were prospectively studied. Multiple data points were recorded including anastomotic location, polyp morphology, resection modality, complications, and technical success.
Over 7 years until November 2022, 2629 lesions were referred. Of these, 10 (0.4%) were LAAPs (median size 35 mm [interquartile range (IQR) 30-40mm]). All LAAPs were removed by piecemeal endoscopic mucosal resection (EMR), most (n=9; 90%) in combination with cold-forceps avulsion with adjuvant snare-tip soft coagulation (CAST). On comparison of the LAAP group with the conventional LNPCP group, CAST was more commonly used (90% vs. 9%; <0.001) and deep mural injury (DMI) type II was more frequent (40% vs. 11%, =0.003); however, significant DMI (III-V) did not occur. At 6 month (IQR 5.25-6 months) surveillance, there was no recurrence in any of the 10 cases. There were no serious adverse events.
LAAPs present unique challenges owing to their location overlying an anastomosis. Despite these challenges they can be safely and effectively managed endoscopically without recurrence at endoscopic follow-up.
大（≥20mm）腺瘤性吻合口息肉（LAAP）并不常见。目前尚无关于其患病率、特征以及内镜切除（ER）疗效的数据。安全有效的 ER 策略可以降低发病率和医疗保健成本。
前瞻性研究了≥20mm（LNPCP）的大型无蒂结直肠息肉（LNPCP）患者，需要进行 ER。记录了多个数据点，包括吻合口位置、息肉形态、切除方式、并发症和技术成功率。
截至 2022 年 11 月，7 年内共转介了 2629 例病变。其中 10 例（0.4%）为 LAAP（中位数大小为 35mm[四分位间距（IQR）30-40mm]）。所有 LAAP 均通过分片内镜黏膜切除术（EMR）切除，其中大多数（n=9；90%）联合冷钳撕除和辅助圈套尖端软凝（CAST）。与常规 LNPCP 组相比，LAAP 组更常使用 CAST（90% vs. 9%，<0.001），且更常发生深壁损伤（DMI）Ⅱ型（40% vs. 11%，=0.003）；然而，并未发生严重的 DMI（Ⅲ-Ⅴ型）。在 6 个月（IQR 5.25-6 个月）的随访中，10 例患者均无复发。无严重不良事件发生。
由于 LAAP 位于吻合口上方，因此存在独特的挑战。尽管存在这些挑战，但它们可以通过内镜安全有效地进行管理，在内镜随访中无复发。
