INTESTINE Vol.18 No.3(4-2)

特集名 今,変わるのか? 大腸微小病変の取り扱い
題名 処置・治療 (2) 微小腫瘍治療後の内視鏡検査間隔
発刊年月 2014年 05月
著者 小林 望 栃木県立がんセンター画像診断部
著者 松田 尚久 国立がん研究センター中央病院内視鏡科
著者 藤井 隆広 藤井隆広クリニック
著者 佐野 寧 佐野病院消化器センター
著者 斎藤 豊 国立がん研究センター中央病院内視鏡科
【 要旨 】 欧米では,大腸ポリープ切除後の内視鏡検査間隔に関するガイドラインが確立しており,初回検査時のポリープの数,大きさ,組織所見に応じて患者のその後のポリープ(あるいは大腸癌)発生リスクを予測し,次回検査時期を推奨している.微小腫瘍のみを有する患者は,より大きなポリープを有する患者よりポリープ発生リスクが低いとされているが,その個数が多い場合(とくに3個以上)にはリスクが高くなる.日本独自のガイドライン作成は急務であり,Japan Polyp Studyの結果が待たれる.
Theme Can we change to treat for diminutive colorectal polyp ?
Title Colonoscopic intervals after removal of diminutive colorectal polyps
Author Nozomu Kobayashi Department of Diagnostic Imaging, Tochigi Cancer Center
Author Takahisa Matsuda Endoscopy Division, National Cancer Center Hospital
Author Takahiro Fujii TF Clinic
Author Yasushi Sano Gastrointestinal Center, Sano Hospital
Author Yutaka Saito Endoscopy Division, National Cancer Center Hospital
[ Summary ] In western countries, surveillance intervals after removal of colorectal polyps are recommended based on the number, size and histology of polyps detected at the baseline colonoscopy. According to these guidelines, patients with diminutive polyps are at a lower risk of polyp recurrence compared to patients with larger polyps. However, patients with three or more diminutive polyps have an increased risk for adenomas, including advanced adenomas during the surveillance period. On the other hand, there are no recommendations or guidelines concerning colonoscopic intervals after polyp removal in Japan. To improve this situation, the Japan Polyp Study (JPS) Workgroup was organized in 2000. Based on the results of retrospective analysis, a multi-center prospective study to determine adequate surveillance intervals after the polyp removal was conducted in 2003. All scheduled examinations were finished by 2012. Data from the JPS revealed the importance not only of size but number of diminutive polyps. In conclusion, diminutive polyps are also one risk factor for polyp recurrence during surveillance. We should take into account these factors to establish Japanese guideline for colonoscopic surveillance after screening and polypectomy.