具有进展期组织学的微小和小结直肠息肉的内镜下特征

Endoscopic Characteristics of Diminutive and Small Colorectal Polyps With Advanced Histology

背景:微小息肉(≤5 mm)和小息肉(6~9 mm)是临床上最常见的结直肠息肉,其中少数具有进展期组织学。目的:分析具有进展期组织学的微小和小结直肠息肉的内镜下特征。方法:回顾性收集2016年6月—2021年9月在宁波市第一医院行结肠镜下息肉切除术的病例,采集临床、内镜和病理资料。采用倾向性评分匹配法为进展期组织学微小和小息肉1:1匹配对照组,以单因素和多因素分析筛选与进展期组织学相关的内镜下特征。结果:2950例患者检出直径10 mm以下的腺瘤性息肉3631个,14个(1.2%)微小息肉存在进展期组织学,均为高级别上皮内瘤变(HGIN);114个(4.6%)小息肉存在进展期组织学,包括109个HGIN和5个黏膜下浸润性癌。504例患者检出直径10 mm以下的锯齿状病变755个,均未发现进展期组织学。多因素Logistic回归分析显示,在微小和小息肉中,鸡皮征(OR=3.790,95%CI:1.767~8.128)、充血(OR=2.802,95%CI:1.450~5.415)、出血(OR=5.074,95%CI:1.511~17.035)、分叶改变(OR=2.522,95%CI:1.247~5.098)和相对凹陷(OR=5.317,95%CI:1.376~20.550)是进展期组织学的独立危险因素,而JNET高风险和内镜下病变形态为隆起型与进展期组织学无关。结论:结肠镜检查时如发现微小或小息肉有鸡皮征、充血、出血、分叶改变和相对凹陷表现,应警惕可能存在进展期组织学。

Background:Diminutive(≤5 mm)and small(6⁃9 mm)polyps are the most common colorectal polyps seen clinically,and a tiny percentage of them contain advanced histology.Aims:To clarify the endoscopic characteristics of diminutive and small colorectal polyps with advanced histology.Methods:A retrospective analysis was conducted in patients undergoing colonoscopic polypectomy in Ningbo First Hospital from June 2016 to September 2021,and the clinical,endoscopic and pathological data were collected.Propensity score matching(1:1)was performed to select the non⁃advanced histology controls comparable with diminutive and small polyps with advanced histology.The endoscopic characteristics related to advanced histology was identified by univariate and multivariate analyses.Results:A total of 3631 diminutive and small adenomatous polyps were detected in 2950 patients,among them,14(1.2%)diminutive polyps and 114(4.6%)small polyps were diagnosed as advanced histology pathologically,with 14 high⁃grade intraepithelial neoplasia(HGIN)in diminutive polyps,and 109 HGIN and 5 submucosal invasive carcinoma in small polyps.For serrated lesions,755 polyps less than 10 mm in diameter were detected in 504 patients,but no advanced histology was diagnosed.Multivariate Logistic regression analysis showed that chicken skin mucosa(OR=3.790,95%CI:1.767⁃8.128),congestion(OR=2.802,95%CI:1.450⁃5.415),hemorrhage(OR=5.074,95%CI:1.511⁃17.035),lobular changes(OR=2.522,95%CI:1.247⁃5.098)and relative depression(OR=5.317,95%CI:1.376⁃20.550)were independent risk factors for advanced histology in diminutive and small polyps,while no correlations were found between JNET classification type 2B and type 3,Paris endoscopic classification type 0⁃Ⅰand advanced histology.Conclusions:When endoscopic characteristics including chicken skin mucosa,congestion,hemorrhage,lobular changes and relative depression are found in diminutive and small colorectal polyps,advanced histology should be suspected.