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Optimal Endoscopic Treatment and Surveillance of Serrated Polyps

机译：最佳内窥镜治疗和锯齿状息肉监测

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Serrated polyps are considered precursor lesions that account for 15% to 30% of colorectal cancers, and they are overrepresented as a cause of interval cancers. They are difficult to detect and resect comprehensively; however, recent data suggest that high definition endoscopy, chromoendoscopy (via spray catheter, pump or orally), narrow band imaging, split-dose bowel preparation and a slower withdrawal (&6 minutes) can all improve detection. Cold snare resection is effective and safe for these lesions, including cold snare piecemeal endoscopic mucosal resection, which is likely to become the standard of care for lesions &10 mm in size. Sessile serrated lesions ≥10 mm in size, those exhbiting dysplasia, or traditional serrated adenomas increase the chance of future advanced neoplasia. Thus, a consensus is emerging: a surveillance examination at 3 years should be recommended if these lesions are detected. Serrated lesions likely carry equivalent risk to adenomas, so future guidelines may consider serrated class lesions and adenomas together for risk stratification. Patients with serrated polyposis syndrome should undergo surveillance every 1 to 2 years once the colon is cleared of larger lesions, and their first degree relatives should undergo screening every 5 years starting at age 40.
机译：锯齿状息肉被认为是占15％至30％的结肠直肠癌的前体病变，它们是持续的，作为间隔癌的原因。它们难以全面检测和切除;然而，最近的数据表明，高清晰度内窥镜检查，微透视（通过喷雾导管，泵或口服），窄带成像，分裂剂量肠道制剂和较慢的取液（＆ 6分钟）都可以改善检测。冷圈切除术对这些病灶有效和安全，包括冷圈零碎的内窥镜粘膜切除，这可能成为病灶的护理标准> 10毫米。无梗塞病灶≥10毫米的大小，那些出现的发育不良或传统的锯齿状腺瘤增加了未来先进肿瘤的机会。因此，出现共识：如果检测到这些病变，应建议3年的监测检查。锯齿状病变可能对腺瘤携带等同的风险，因此未来的指导方针可以考虑锯齿状病变和腺瘤共同进行风险分层。患有锯齿状蛋白患者的患者应每1至2年一次进行一次监测，一旦结肠被清除了较大的病变，他们的第一学位亲属应该每5年开始筛选40岁。

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