SNFGE SNFGE
 
Thématique :
- Endoscopie - Imagerie
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Christophe CELLIER
Coup de coeur :
 
 
Gastroenterology
  2017/09  
 
  2017 Sep;153(3):732-742.e1.  
  doi: 10.1053/j.gastro.2017.05.047.  
 
  Risk Stratification for Covert Invasive Cancer Among Patients Referred for Colonic Endoscopic Mucosal Resection: A Large Multicenter Cohort.  
 
  Burgess NG, Hourigan LF, Zanati SA, Brown GJ, Singh R, Williams SJ, Raftopoulos SC, Ormonde D, Moss A, Byth K, Mahajan H, McLeod D, Bourke MJ  
  https://www.ncbi.nlm.nih.gov/pubmed/28583826  
 
 

Abstract

BACKGROUND & AIMS:

Among patients with large colorectal sessile polyps or laterally spreading lesions, it is important to identify those at risk for submucosal invasive cancer (SMIC). Lesions with overt endoscopic evidence of SMIC are referred for surgery, although those without these features might still contain SMIC that is not visible on endoscopic inspection (covert SMIC). Lesions with a high covert SMIC risk might be better suited for endoscopic submucosal dissection than for endoscopic mucosal resection (EMR). We analyzed a group of patients with large colon lesions to identify factors associated with SMIC, and examined lesions without overt endoscopic high-risk signs to determine factors associated with covert SMIC.

METHODS:

We performed a prospective cohort study of consecutive patients referred for EMR of large sessile or flat colorectal polyps or laterally spreading lesions (≥20 mm) at academic hospitals in Australia from September 2008 through September 2016. We collected data on patient and lesion characteristics, outcomes of procedures, and histology findings. We excluded serrated lesions from the analysis of covert SMIC due to their distinct phenotype and biologic features.

RESULTS:

We analyzed 2277 lesions (mean size, 36.9 mm) from 2106 patients (mean age, 67.7 years; 53.2% male). SMIC was evident in 171 lesions (7.6%). Factors associated with SMIC included Kudo pit pattern V, a depressed component (0-IIc), rectosigmoid location, 0-Is or 0-IIa+Is Paris classification, non-granular surface morphology, and increasing size. After exclusion of lesions that were obviously SMIC or serrated, factors associated with covert SMIC were rectosigmoid location (odds ratio, 1.87; P = .01), combined Paris classification, surface morphology (odds ratios, 3.96-22.5), and increasing size (odds ratio, 1.16/10 mm; P = .012).

CONCLUSIONS:

In a prospective study of 2106 patients who underwent EMR for large sessile or flat colorectal polyps or laterally spreading lesions, we associated rectosigmoid location, combined Paris classification and surface morphology, and increasing size with increased risk for covert malignancy. Rectosigmoid 0-Is and 0-IIa+Is non-granular lesions have a high risk for malignancy, whereas proximally located 0-Is or 0-IIa granular lesions have a low risk. These findings can be used to inform decisions on which patients should undergo endoscopic submucosal dissection, EMR, or surgery. ClinicalTrials.gov, Number: NCT02000141.

 

 
Question posée
 
Stratification du risque de cancer invasif pour les lésions coliques sessiles ou planes étendues référées pour mucosectomie.
 
Question posée
 
Cette série issue d'une énorme cohorte de suivi australienne suggère que les lésions sigmoïdiennes, 0-Is or 0-IIa+Is dans la classification de Paris et d'une taille > 2 cm ont une plus forte probabilité d'invasion sous muqueuse et que ces critères pourraient être pris en compte dans la stratégie thérapeutique pour discuter une éventuelle dissection sous muqueuse ou une colectomie.
 
Commentaires

Cette étude est démonstrative par le nombre important de lésions évaluées, avec cependant des résultats connus hormis la localisation sigmoïdienne pour la prédiction endoscopique des lésions coliques invasives. Par ailleurs le risque plus important de perforation de la dissection sous muqueuse dans le sigmoïde devrait également être pris en compte dans la stratégie de résection par voie endoscopique. 

 
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