대장 용종의 내시경적 치료 = The Results of Endoscopic Treatment of Colonic Polyp

다국어 초록 (Multilingual Abstract)

On the aspect of adenoma-carcinoma sequence, the removal of colonic polyps is important for the secondary prevention of development of colon cancer. We studied the therapeutic and side effects of various endoscopic methods sueh as snare polypectomy, laser photocoagulation, and electrocoagulation for the treatment of colonic polyps, retrospectively. Among 192 polyps which removed endoscopically from 128 patients for 11 and half years, 129 (69%) were located on the rectosigmoid region, 95 (49%) were diminutive polyps, 94 (49%) were having stalk, and pathologically 18 (9%) hyperplastic polyps, 150 (79%) adenomatous polyps, 2 (1%) carcinoma were included. The rate of synchronous polyps was 23%. The snare polypectomy, laser photocoagulation, and elctrocagulation were applied to 54, 113, 20 polyps, respectively. The overall incomplete removal rate until the last follow-up was 5% and laser photocoagulation showed higher (8%) incomplete removal rate than that of snare polypectomy or electrocoagulation method. The overall major complication rate was 3%, which included 1.5% of bleeding and 1.5% of perforation. Snare polypectomy showed higher perforation rate (6%) comparing with that of laser or electrocoagulation. We thought laser photocoagulation and electrocagulation were both relatively safe methods in contrast to the literally reported results. During average 12 months of follow-up, 4 (8%) of 52 patients who were followed more than 1 month, revealed new polyp. We concluded that snare polypectomy was the method of choice for the pedunculated polyps with benitit of complete recovery of the tissue and single session of the procedure in the almost all cases. But sessile polyps and very large polyps were not indicated to the snare polypectomy due to lack of stalk and bleeding risk. Laser photocoagulation and electrocoagulation were inclicated to the small, seesile polyps or large polyps in the patients with poor operative risk. Both methods revealed considerable safety. So, above 3 methods were complementary to one another. The follow-up schedule after removal of the colonic polyp should be established on the base of risk of polyp recurrence and cost-benefit effectiveness of repeated colonoscopy.