Diagnosis Algorithm And Endoscopic Therapy Of Large Intestine Neoplasia
DOI:
https://doi.org/10.11603/2414-4533.2016.4.7179Abstract
Colonoscopy (CS) is a “gold” standard for detection of colon tumors. However, not all of them are identified and removed by the CS. Quality inspection and correct diagnosis depends on the individual choice of the method of preparation, depending on the time of the CS, the presence of comorbidity, constipation. Chromoscopy increases the capabilities of the standard endoscopic investigation of colon. It allows to detect most of neoplasia particularly small dimensions and flat lesions, mainly, in the right part of colon compared to colonoscopy with white light. Also, this technique can be used in combination with a magnification that allows endoscopic forecast morphological diagnosis of neoplasia. Identification and removal of small lesions (less than 10 mm) both during insertion and withdrawal of colonoscope may safely take less time than the “traditional” removing strategy only during withdrawal of colonoscope. Considering the pragmatic approach to the choice of method of treatment of the colonic proximal neoplasms, all polyps proximal to the sigmoid colon adenoma and all regardless of their location must be removed. The aim of our study was to develop an algorithm for the diagnosis and endoscopic treatment of colon neoplasia. From 2007 to 2015 4615 patients were examined. In the first period of our work (from 2007 to 2011) CS was conducted in 2375 patients by the standard technique (group 1) – CS was carried out in white light and in case of lesion detection, the biopsy had been taken, and after morphological verification the lesions had been removed. During this period, based on the studies we developed an algorithm of diagnosis and endoscopic treatment of colon neoplasia. In the second period (2011 to 2015) in accordance with an algorithm 2240 patients were examined (group 2). In group 1 patients were identified 126 (5.3 %) and, in group 2 – 463 (20.7 %) neoplasms, which was significantly higher (P <0.0001, c2 = 245.79). In group 1 all neoplasms had removed only by using polypectomy snare, and in 2 – 213 lesions resected by using polypectomy snare (0-Ip – 126 and 87 – 0-Isp), mucosal resection had performed in 227 cases (114 – 0-Isp, 104 – 0-IIa and 9 – 0-IIb), and submucosal dissection in 23 (11 – LST NG, 5 – 0, 0-IIa + and 7-Is – 0-Is + 0-IIa). Implementation of the developed algorithm of diagnosis and treatment of colon lesions increased detection of lesions, improved their results of endoscopic treatment and reduce the number of retransmissions of the CS on 16 %.
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