传统锯齿状腺瘤患者比一般腺瘤患者更易发生高风险异时性息肉:一项多中心前瞻性研究

Jin Young Yoon, MD, Hyung Tae Kim, MD, Sung Pil Hong, MD, PhD, Hyun Gun Kim, MD, Jin-Oh Kim, MD, Dong-Hoon Yang, MD, Dong Il Park, MD, Seun Ja Park, MD, Hyun-Soo Kim, MD, Bora Keum, MD, Cheol Hee Park, MD, Chang Soo Eun, MD, Suck-Ho Lee, MD, Il Hyun Baek, MD, Dong Kyung Chang, MD, PhD, Tae Il Kim, MD, PhD1

Background and Aims: Although the malignant progression of serrated polyps has been clearly documented, the malignant potential of the traditional serrated adenoma (TSA) subtype has not been established. We compared the prevalence of metachronous polyps in surveillance colonoscopies between patients with TSA and those with conventional adenomas (CAs).

Methods: Four hundred twenty patients were diagnosed with TSAs by current diagnostic criteria at 10 tertiary care university hospitals in Korea from January 2003 to December 2005; 186 patients who received surveillance colonoscopy after removal of initial polyps were enrolled. During the same time period, 372 age- and sex-matched patients diagnosed with CAs were used as a control group.

Results: TSA patients had a significantly higher recurrence rate of colorectal polyps compared with CA patients (66.1% vs 43.5%, respectively). TSA patients had a greater number (3 vs 2) and larger size (8.6 ± 5.7 vs 6.3 ± 5.2 mm) of recurrent polyps compared with CA patients. TSA patients also had a higher rate of CA (54.8% vs 37.9%), serrated adenoma (14.0% vs. 0.8%), and hyperplastic polyp (33.3% vs. 13.7%) recurrence compared with CA patients. TSA patients had significantly greater odds of having a recurrent high-risk polyp than CA patients (odds ratio, 2.37; 95% confidence interval, 1.55-3.63).

Conclusions: In comparison with patients with CAs, patients with TSAs have a higher metachronous occurrence rate of all polyp subtypes including CAs, serrated adenomas, and hyperplastic polyps. Moreover, the presence of TSAs is an independent predictor of a high-risk polyp occurrence. (Gastrointest Endosc 2015;82:1087-93.)


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