대장내시경 검사로 용종을 제거하면 대장암 발생을 줄일 수 있다.

Research Summary & Abstract: Post-polypectomy colonoscopy surveillance is widely implemented to reduce colorectal cancer incidence and mortality, yet increasing evidence raises concerns about whether current strategies are optimally balanced in terms of benefit, burden, and resource use. At least some individuals currently classified as being high risk for post-polypectomy colorectal cancer might actually have a low absolute risk, suggesting that surveillance might be overused in this group of patients. At the same time, colonoscopy surveillance imposes considerable burden at the patient, health-care system, and societal levels, including procedural risks, costs, and pressure on endoscopy capacity. This Viewpoint critically examines the limitations underlying current post-colonoscopy surveillance strategies, including reliance on historical data with inadequate collection of quality indicators, insufficient focus on the absolute risk of colorectal cancer, and potential misclassification of patients' risk. We argue that these limitations might have led to suboptimal allocation of surveillance intensity. We advocate for a shift towards a more comprehensive risk-stratified framework, in which surveillance decisions are guided by absolute colorectal cancer risk thresholds and could incorporate less invasive triage approaches for lower-risk individuals. Overall, we propose rethinking post-polypectomy surveillance to better align clinical practice with contemporary evidence with the goal of improving patient outcomes while minimising unnecessary interventions and health-care burden.

Research Summary & Abstract: BACKGROUND & AIMS: Defining precision postpolypectomy surveillance intervals is essential to optimize the balance between colonoscopy resource use and colorectal cancer (CRC) risk reduction within population-based fecal immunochemical test (FIT) screening programs. We sought to develop fecal hemoglobin (f-Hb) concentration-guided surveillance intervals and integrate them into the existing surveillance framework. METHODS: Between 2010 and 2015, 3,929,387 individuals participated in FIT screening, of whom 89,771 participants aged 50 to 74 years with f-Hb ≥20 μg Hb/g and complete colonoscopy after polypectomy were enrolled and monitored through 2018 for ascertaining incident CRCs. CRC risks across different f-Hb concentrations were estimated using an accelerated failure time model, and surveillance intervals were proportionally adjusted-shortened at higher f-Hb and extended at lower levels. We compared pragmatic, precision-oriented surveillance intervals with current guidelines to evaluate the extent of colonoscopy reduction without compromising CRC risk. RESULTS: There were 89,771 postpolypectomy individuals stratified as high-risk (49.5%) and low-risk (50.5%) groups based on the United States surveillance guideline. During a mean 5.5-year follow-up, CRC incidence was 2.8/1000 person-years (95% confidence interval, 2.7-3.0), increasing stepwise from 2.2/1000 person-years at 20 to 49 μg/g to 4.0/1000 person-years at ≥450 μg/g. Hypothetical f-Hb-guided surveillance intervals were lengthened for low-risk individuals with low f-Hb and shortened for those with elevated f-Hb within both risk categories. If adopting this precision approach, colonoscopy demand could be reduced by 9.8% vs current United States guidelines, while maintaining comparable CRC risk. CONCLUSIONS: Precision surveillance intervals guided by f-Hb can complement current guideline-based strategies by optimizing colonoscopy resource use while preserving the benefits of FIT-based CRC screening programs.

Research Summary & Abstract: Background: Colonoscopy offers higher diagnostic sensitivity than other colorectal cancer screening methods and provides the advantage of both diagnostic tissue sampling and polyp removal. Since the majority of colorectal cancers evolve from adenomatous polyps, polyp resection through colonoscopy is widely considered an effective method of preventing colorectal cancer and reducing mortality rates. Current Concepts: Determining colorectal polyp size and shape requires comprehensive endoscopy with enhanced imaging techniques to choose treatment directions and the appropriate colorectal polypectomy method. The selection of the polypectomy method is contingent upon the polyp’s attributes and possible malignancy according to US Multi-Society Task Force on Colorectal Cancer and European gastrointestinal endoscopy guidelines. This article examines eight polypectomy procedures: cold forceps polypectomy, hot biopsy polypectomy, cold snare polypectomy, hot snare polypectomy, endoscopic mucosal resection (EMR), and modified EMR techniques. Each method has unique benefits and is suitable for particular polyp types and sizes. Piecemeal EMR and endoscopic submucosal dissection offer alternatives for larger or challenging lesions that require careful planning and follow-up. After endoscopic resection of early colorectal cancer, further surgery may be necessary depending on the risk of lymph node metastasis as determined by specific histologic findings following Korean and Japanese guidelines. Discussion and Conclusion: The choice of endoscopic resection technique, which depends on factors such as polyp shape, size, and location as well as endoscopist skill, is crucial for ensuring complete polyp removal.