Prevalence of Adenoma with Advanced Histology in Diminutive Colorectal Polyps / 胃肠病学

ABSTRACT

Background:Recently,the American Society for Gastrointestinal Endoscopy published the PIVI( Preservation and Incorporation of Valuable Endoscopic Innovations)initiative regarding to the“predict,resect,and discard”strategy on diminutive(≤5 mm)colorectal polyps. The low prevalence of adenoma with advanced histology( containing ≥25%villous component,or high-grade intraepithelial neoplasia,or submucosal invasive carcinoma)in diminutive polyps would provide high confidence for endoscopists to adopt the strategy. Aims:To investigate the prevalence of adenoma with advanced histology in diminutive colorectal polyps. Methods:Data of diameter,location and morphology of colorectal polyps were collected prospectively from patients undergoing colonoscopy at Digestive Endoscopy Centre,Shanghai Ren Ji Hospital from Jan. 2013 to Jun. 2013. The polyps were resected,placed in a unique specimen vial,and sent for histological evaluation. Results:A total of 1 986 colorectal polyps were enrolled in the study,including 900(45. 3%) diminutive polyps(≤5 mm),521(26. 2%)small polyps(6-9 mm)and 565(28. 4%)large polyps(≥10 mm). Prevalence of adenoma with advanced histology in diminutive polyps was significantly lower than those in small and large polyps(1. 1% vs. 8. 4% and 43. 7%,P<0. 05),and was not correlated with the location and morphology of diminutive polyps. Submucosal invasive carcinoma was found in 4. 6% of large polyps,0. 4% of small polyps,and 0% of diminutive polyps. Conclusions:The very low prevalence of adenoma with advanced histology and absence of submucosal invasive carcinoma in diminutive colorectal polyps favours the potential practice of“predict,resect,and discard”strategy in the patient population studied.