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Recurrence rates after endoscopic resection of large colorectal polyps:A systematic review and meta-analysis

World Journal of Gastroenterology 2022年第29期28卷 4007-4018页

作者： Carola Rotermund roupen djinbachian Mahsa Taghiakbari Markus D Enderle Axel Eickhoff Daniel von Renteln Research and Basic Technologies ERBE Elektromedizin GmbHTuebingen 72072Germany Division of Internal Medicine Montreal University Hospital CenterMontreal QC H2X 3E4Canada Montreal University Hospital Research Center Montreal University Hospital CenterMontreal QC H2X 3E4Canada Department of Internal Medicine II Klinikum HanauHanau 63450Germany

BACKGROUND Complete polyp resection is the main goal of endoscopic removal of large colonic *** techniques have evolved in recent years and endoscopic submucosal dissection(ESD),endoscopic mucosal resection(EMR)with margin ablation,cold snare polypectomy(CSP),cold EMR,and underwater EMR have been ***,efficacy of these techniques with regard to local recurrence rates(LRRs)vs traditional hot snare polypectomy and standard EMR remains *** To analyze LRR of large colonic polyps in a systematic review and *** MEDLINE,EMBASE,EBM Reviews,and CINAHL were searched for prospective studies reporting LRR or incomplete resection rate(IRR)after colonic polypectomy of polyps≥10 mm,published between January 2011 and July *** outcome was LRR for polyps≥10 *** Six thousand nine hundred and twenty-eight publications were identified,of which 34 prospective studies were *** for polyps≥10 mm at up to 12 mo’follow-up was 11.0%(95%CI,7.1%-14.8%;15 studies;4904 polyps).ESD(1.7%;95%CI,0%-3.4%;3 studies,221 polyps)and endoscopic mucosal resection with margin ablation(3.3%;95%CI,2.2%-4.5%;2 studies,947 polyps)significantly reduced LRR vs standard EMR without(15.2%;95%CI,12.5%-18.0%;4 studies,650 polyps)or with unsystematic margin ablation(16.5%;95%CI,15.2%-17.8%;6 studies,3031 polyps).CONCLUSION LRR is significantly lower after ESD or EMR with routine margin ablation;thus,these techniques should be considered standard for endoscopic removal of large colorectal *** techniques,such as CSP,cold EMR,and underwater EMR require further evaluation in prospective studies before their routine implementation in clinical practice can be recommended.

关键词： Colonoscopy Adenoma Polyp Endoscopic mucosal resection Colorectal cancer

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Non-optical polyp-based resect and discard strategy:A prospective clinical study

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World Journal of Gastroenterology 2022年第19期28卷 2137-2147页

作者： Mahsa Taghiakbari Celia Hammar Mira Frenn roupen djinbachian Heiko Pohl Erik Deslandres Simon Bouchard Mickael Bouin Daniel von Renteln Department of Gastroenterology Montreal University Hospital Research Center(CRCHUM)Montréal H2X 0A9QuebecCanada Department of Gastroenterology University of MontrealFaculty of MedicineMontreal H2X 0A9QuebceCanada Department of Internal Medicine University of Montreal Hospital Center(CHUM)Montreal H2X 0A9QuebecCanada Department of Medicine Veterans Affairs Medical CenterWhite River JunctionVT 05009United States Department of Gastroenterology Dartmouth Geisel School of Medicine and The Dartmouth InstituteHanoverNH 03755United States

BACKGROUND Post-polypectomy surveillance intervals are currently determined based on pathology *** To evaluate a polyp-based resect and discard model that assigns surveillance intervals based solely on polyp number and *** Patients undergoing elective colonoscopies at the Montreal University Medical Center were enrolled *** polyp-based strategy was used to assign the next surveillance interval using polyp size and *** intervals were also assigned using optical diagnosis for small polyps(<10 mm).The primary outcome was surveillance interval agreement between the polyp-based model,optical diagnosis,and the pathology-based reference standard using the 2020 United States Multi-Society Task Force *** outcomes included the proportion of reduction in required histopathology evaluations and proportion of immediate post-colonoscopy recommendations provided to *** Of 944 patients(mean age 62.6 years,49.3%male,933 polyps)were *** surveillance interval agreement for the polyp-based strategy was 98.0%[95%confidence interval(CI):0.97-0.99]compared with pathology-based *** diagnosis-based intervals achieved 95.8%(95%CI:0.94-0.97)agreement with *** using the polyp-based strategy and optical diagnosis,the need for pathology assessment was reduced by 87.8%and 70.6%,*** polyp-based strategy provided 93.7%of patients with immediate surveillance interval recommendations vs 76.1%for optical *** The polyp-based strategy achieved almost perfect surveillance interval agreement compared with pathology-based assignments,significantly reduced the number of required pathology evaluations,and provided most patients with immediate surveillance interval recommendations.

关键词： Colonoscopy Colorectal pathology Colorectal adenomas Endoscopy Surveillance Optical diagnosis

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