遗传性结直肠肿瘤研究进展

Effect of preventive measures after colonoscopic high-frequency electroresection for colorectal polyps on complications

AIM: To explore the necessity of preventive measures after colonoscopic high-frequency electroresection for colorectal polyps by evaluating the effect of all preventive measures on the incidence of complications.

METHODS: Clinical data for 1280 patients who underwent therapeutic colonoscopy at the Affiliated Hospital of Qingdao University were analyzed retrospectively.

RESULTS: Of all the 1280 patients, 1273 (99.45%) recovered well and had no discomfort, 5 (0.39%) had hemorrhage of different degrees and 2 (0.16%) had post-polypectomy coagulation syndrome.

CONCLUSION: Adopting preventive measures in patients who undergo colonoscopic high-frequency electroresection for colorectal polyps can prevent the occurrence of complications such as hemorrhage and/or perforation.

Colonoscopic electrosurgical resection of high-risk polyps: Pretreatment methods

AIM: To discuss the pretreatment techniques and methods for colonoscopic electrosurgical resection of high-risk polyps.

METHODS: This study comprised 131 patients, who had a total of 145 high-risk colorectal polyps, including wide-pedicle polyps, large polyps, and those with a hyperemic surface, obvious blood vessels through the base, or poor endoscopic exposure). For wide-pedicle polyps (pedicle diameter > 1 cm), nylon snare ligation was performed before electrosurgical resection. For large pedunculated polyps (>2 cm, pedicle diameter < 1 cm), titanium clipping was performed before electrosurgical resection. For 2.0-3.0 cm wide-base/Artie polyps, fully lifting of polyps was achieved by basal submucosal injection of liquid before the resection of polyps. For polyps with a hyperemic surface, obvious blood vessels through the base, or poor endoscopic exposure, trial colonoscopic resection was initially performed. If the resection was difficult, immediate laparoscopic treatment was given. Intestinal bleeding, intestinal perforation and other complications were recorded.

RESULTS: Nylon snare ligation was performed in 10 polyps, metal titanium clamping in 32 polyps, basal submucosal injection in 60 polyps, colonoscopic resection in 31 polyps, and laparoscopic resection in 12 polyps. No intestinal bleeding, intestinal perforation or other severe complications occurred.

CONCLUSION: Effective pretreatment can improve the management of high-risk intestinal polyps, and endoscopic treatment can improve the safety of treatment and avoid the occurrence of intestinal bleeding, intestinal perforation and other complications.

Advances in the prevention, diagnosis and treatment of Peutz-Jeghers syndrome

Peutz-Jeghers syndrome (PJS) is an autosomal dominant inherited disease caused by inactivating germline mutations of the LKB1/STK11 gene and characterized by mucocutaneous pigmentation, multiple gastrointestinal hamartomatous polyps and family history. Life-threatening complications include intestinal obstruction and an increased risk for developing gastrointestinal malignancies and extraintestinal cancers. Surgery and endoscopic therapy are still main ways to manage gastrointestinal polyposis in PJS patients, and double-balloon enteroscopy has important clinical significance in the diagnosis and treatment of this disease. With the development of translational medicine, molecular targeted therapy (e.g., selective COX-2 inhibitors) brings a new approach to preventive treatment of gastrointestinal polyposis in PJS patients. Traditional Chinese medicine provides an alternative choice. In this paper, we review the recent advances in the prevention, diagnosis and treatment of PJS.