OBJECTIVE:Change in colon polyp size over time has not been well characterized. It has been inferred that some polyps will increase in size, leading to an increased risk of progressing to cancer, whereas other polyps may spontaneously regress. To develop a better understanding of the natural history of colon polyps, we prospectively investigated change in polyp size over a 2-yr period.

METHODS:Patients were enrolled if they had an endoscopically detected proximal rectal or sigmoid polyp measuring 3-9 mm. The index polyp site was then permanently marked with an adjacent India ink tattoo to allow definitive future localization of the polyp. Patients underwent flexible sigmoidoscopy at 6-month intervals, and at each examination, the polyp size was carefully measured with open biopsy forceps. After a maximum of 2 yr, each polyp was removed and the histology determined.

RESULTS:Thirty polyps were followed in 26 patients who completed the study. Twelve polyps were tubular adenomas (TA), one was tubulovillous, 14 were hyperplastic polyps (HP), two had no pathological diagnosis, and one was a leiomyoma. HP were more likely to decrease in size than were TA. Three polyps demonstrated fast growth rates (2-4 mm/yr), and all were TA. Two polyps were removed early because their size had reached 1 cm or more. Both of those polyps were TA. No polyps regressed completely during the 2 yr of the study; neither did we find consistent linear growth rates.

CONCLUSIONS:In contrast to prior reports, in this study, after polyps had been definitively localized with India ink, we observed no complete polyp regressions.

译文

目标 : 结肠息肉大小随时间的变化尚未得到很好的表征。据推断,一些息肉的大小会增加,导致发展为癌症的风险增加,而其他息肉可能会自发消退。为了更好地了解结肠息肉的自然史,我们前瞻性地研究了2年内息肉大小的变化。
方法 : 如果患者在内窥镜下检测到的近端直肠或乙状结肠息肉测量3-9毫米。然后,将索引息肉部位永久标记为相邻的印度墨水纹身,以便将来对息肉进行明确的定位。患者每隔6个月接受一次柔性乙状结肠镜检查,每次检查时,均使用开放式活检钳仔细测量息肉大小。最多2年后,切除每个息肉并确定组织学。
结果 : 对完成研究的26例患者进行了30例息肉的随访。12个息肉为管状腺瘤 (TA),1个为管状绒毛状息肉,14个为增生性息肉 (HP),2个无病理诊断,1个为平滑肌瘤。HP比TA更有可能缩小。三个息肉显示出快速的生长速率 (2-4毫米/年),并且都是TA。由于两个息肉的大小已达到1厘米或更多,因此早期移除了两个息肉。这两个息肉都是TA。在研究的2年中,没有息肉完全消退; 我们也没有发现一致的线性增长率。
结论 : 与先前的报告相反,在本研究中,在印度墨水明确定位息肉之后,我们没有观察到完全的polyp回归。

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