大的非梗阻性结直肠病变片状内镜粘膜切除术后 12 个月首次监测结肠镜检查的安全性。

IF 6.7 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gastrointestinal endoscopy Pub Date : 2024-11-01 DOI:10.1016/j.gie.2024.05.008

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引用次数: 0

摘要

背景和目的：在对≥20毫米的非截石性结直肠病变进行片状内镜粘膜切除术（pEMR）后，指南建议在6个月时进行首次内镜监测。然而，对于选定的低风险病变，12 个月的首次监测可能就足够了，而且可以节省一次监测检查的费用、风险和不便：方法：我们回顾性地检查了前瞻性收集的数据库，其中包括 2019 年 8 月至 2023 年 4 月期间转诊至本中心进行内镜下切除术的所有结直肠病变。我们报告了通过 pEMR 切除的≥20 mm 的结直肠病变的复发率，这些病变被分配到 6 个月的首次监测或分配到 12 个月的首次监测（或分配到 6 个月但直到 10 个月后才复查）：共有 561 个≥20 毫米的非截石性病灶接受了首次随访，其中 443 名患者的 490 个病灶被指定接受为期 6 个月的监测，65 名患者的 71 个病灶被指定接受为期 12 个月的监测。接受 12 个月监测的病变更小（平均大小为 25.9 ± 6.1 毫米 vs. 37.0 ± 17.4 毫米），更有可能呈锯齿状（63.4% vs. 9.6%），更常采用冷冻 pEMR 切除（74.6% vs. 20.4%）。24 名接受 6 个月监测的患者中有 29 例病变在 10 个月后复发，其复发数据被纳入接受 12 个月监测的组别中。6 个月和 12 个月的总复发率分别为 10.0%（46/461）和 9.0%（9/100）。6 个月和 12 个月时的平均复发尺寸分别为 10.9 ± 6.2 毫米和 4.2 ± 1.9 毫米。6个月监测组中有一名患者的pEMR部位发生了癌变，但在6个月或12个月时，没有其他复发患者发生癌变或高级别发育不良：结论：对于经 pEMR 切除的≥20 毫米的特定结直肠病变，12 个月的监测似乎是可以接受的。对于选定的病变，有必要进行一项随机试验，比较最初 6 个月和 12 个月的监控。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Safety of first surveillance colonoscopy at 12 months after piecemeal EMR of large nonpedunculated colorectal lesions

查看原文本刊更多论文

Safety of first surveillance colonoscopy at 12 months after piecemeal EMR of large nonpedunculated colorectal lesions

Background and Aims

After piecemeal EMR (pEMR) of nonpedunculated colorectal lesions ≥20 mm, guidelines recommend first endoscopic surveillance at 6 months. However, initial surveillance at 12 months may be adequate for selected low-risk lesions and could save the cost, risk, and inconvenience of 1 surveillance examination.

Methods

This study retrospectively examined a prospectively collected database of all colorectal lesions referred to our center for endoscopic resection between August 2019 and April 2023. We report recurrence rates of patients with colorectal lesions ≥20 mm removed by pEMR who were assigned to 6-month first surveillance or to 12-month first surveillance (or assigned to a 6-month surveillance visit but did not return until after 10 months).

Results

There were 561 nonpedunculated lesions ≥20 mm that underwent first follow-up, including 490 lesions in 443 patients assigned to 6-month surveillance and 71 lesions in 65 patients assigned to 12-month surveillance. Lesions assigned to 12-month surveillance were smaller (mean size, 25.9 ± 6.1 mm vs 37.0 ± 17.4 mm), more likely serrated (63.4% vs 9.6%), and more often removed by cold pEMR (74.6% vs 20.4%). Twenty-nine lesions in 24 patients assigned to 6-month surveillance presented after 10 months, and their recurrence data were included in the group assigned to 12-month surveillance. Overall recurrence rates at 6 months and 12 months were 10.0% (46 of 461) and 10.0% (10 of 100), respectively. Mean recurrence sizes at 6 and 12 months were 10.9 ± 6.2 mm and 5.0 ± 3.1 mm, respectively. One patient in the 6-month surveillance group had cancer at the pEMR site, but no other recurrences at 6 or 12 months had either cancer or high-grade dysplasia.

Conclusions

Twelve-month surveillance seems acceptable for selected colorectal lesions ≥20 mm removed by pEMR. A randomized trial comparing initial 6-month versus 12-month surveillance is warranted for selected lesions.

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来源期刊

Gastrointestinal endoscopy 医学-胃肠肝病学

CiteScore

10.30

自引率

7.80%

发文量

1441

审稿时长

38 days

期刊介绍： Gastrointestinal Endoscopy is a journal publishing original, peer-reviewed articles on endoscopic procedures for studying, diagnosing, and treating digestive diseases. It covers outcomes research, prospective studies, and controlled trials of new endoscopic instruments and treatment methods. The online features include full-text articles, video and audio clips, and MEDLINE links. The journal serves as an international forum for the latest developments in the specialty, offering challenging reports from authorities worldwide. It also publishes abstracts of significant articles from other clinical publications, accompanied by expert commentaries.