Groza Andrei Lucian, Miutescu Bogdan, Tefas Cristian, Popa Alexandru, Ratiu Iulia, Sirli Roxana, Popescu Alina, Motofelea Alexandru Catalin, Tantau Marcel
3rd Department of Internal Medicine, Iuliu Haţieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania.
Advanced Regional Research Center in Gastroenterology and Hepatology, Department VII: Internal Medicine II, Discipline of Gastroenterology and Hepatology, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania.
Life (Basel). 2024 Apr 21;14(4):532. doi: 10.3390/life14040532.
Diminutive polyps present a unique challenge in colorectal cancer (CRC) prevention strategies. This study aims to assess the characteristics and variables of diminutive polyps in a Romanian cohort, intending to develop a combined resect-and-retrieve or resect-and-discard strategy that reduces the need for an optical diagnosis.
A prospective cohort study was conducted at two endoscopy centers in Romania from July to December 2021. Adult patients undergoing colonoscopies where polyps were identified and resected were included. Endoscopic procedures employed advanced diagnostic features, including blue-light imaging (BLI) and narrow-band imaging (NBI). Logistic regression analysis was utilized to determine factors impacting the probability of adenomatous polyps with high-grade dysplasia (HGD).
A total of 427 patients were included, with a mean age of 59.42 years (±11.19), predominantly male (60.2%). The most common indication for a colonoscopy was lower gastrointestinal symptoms (42.6%), followed by screening (28.8%). Adequate bowel preparation was achieved in 87.8% of cases. The logistic regression analysis revealed significant predictors of HGD in adenomatous polyps: age (OR = 1.05, 95% CI: 1.01-1.08, = 0.01) and polyp size (>5 mm vs. ≤5 mm, OR = 4.4, 95% CI: 1.94-10.06, < 0.001). Polyps classified as Paris IIa, Ip, and Isp were significantly more likely to harbor HGD compared to the reference group (Is), with odds ratios of 6.05, 3.68, and 2.7, respectively.
The study elucidates significant associations between the presence of HGD in adenomatous polyps and factors such as age, polyp size, and Paris classification. These findings support the feasibility of a tailored approach in the resect-and-discard and resect-and-retrieve strategies for diminutive polyps, potentially optimizing CRC prevention and intervention practices. Further research is warranted to validate these strategies in broader clinical settings.
微小息肉在结直肠癌（CRC）预防策略中带来了独特的挑战。本研究旨在评估罗马尼亚队列中微小息肉的特征和变量，旨在制定一种联合切除并取回或切除并丢弃的策略，以减少光学诊断的需求。
2021年7月至12月在罗马尼亚的两个内镜中心进行了一项前瞻性队列研究。纳入接受结肠镜检查且息肉被识别并切除的成年患者。内镜检查采用了先进的诊断特征，包括蓝光成像（BLI）和窄带成像（NBI）。采用逻辑回归分析来确定影响高级别异型增生（HGD）腺瘤性息肉发生概率的因素。
共纳入427例患者，平均年龄59.42岁（±11.19），男性占主导（60.2%）。结肠镜检查最常见的指征是下消化道症状（42.6%），其次是筛查（28.8%）。87.8%的病例实现了充分的肠道准备。逻辑回归分析揭示了腺瘤性息肉中HGD的显著预测因素：年龄（OR = 1.05，95% CI：1.01 - 1.08，P = 0.01）和息肉大小（>5 mm与≤5 mm相比，OR = 4.4，95% CI：1.94 - 10.06，P < 0.001）。与参照组（Is）相比，分类为巴黎IIa、Ip和Isp的息肉更有可能存在HGD，优势比分别为6.05、3.68和2.7。
该研究阐明了腺瘤性息肉中HGD的存在与年龄、息肉大小和巴黎分类等因素之间的显著关联。这些发现支持了针对微小息肉的切除并丢弃和切除并取回策略采用量身定制方法的可行性，可能优化CRC的预防和干预措施。有必要进行进一步研究以在更广泛的临床环境中验证这些策略。
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