Natural History of the Small Colorectal Adenomas―Optimal Surveillance Regarding the Risk Factor Takashi Hisabe 1 , Sumio Tsuda 1 , Suketo Sou 1 , Takashi Nagahama 1 , Yasuhiro Takaki 1 , Fumihito Hirai 1 , Toshiyuki Matsui 1 , Hiroshi Tanabe 2 , Akinori Iwashita 2 1Department of Gastroenterology, Fukuoka University Chikushi Hospital, Chikushino, Japan 2Department of Pathology, Fukuoka University Chikushi Hospital, Chikushino, Japan Keyword: 大腸腺腫 , 経過観察 , 生検 , 発育進展 pp.1459-1469
Published Date 2007/9/25
DOI https://doi.org/10.11477/mf.1403101192
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 There is still no consensus regarding the handling of small colorectal adenomas, and there have been hardly any reports in which long-term follow-up has been performed on the basis of histological changes or endoscopic findings. In this study we assessed the development and progression by endoscopic follow-up for a mean period of 43.1 months of 408 lesions in 332 cases of elevated type or superficial elevated type tumors under 10 mm in diameter diagnosed as adenomas with mild or moderate atypia on the basis of the initial biopsy, and we discuss optimal surveillance from the standpoint of the natural history of colorectal adenomas.

 Of the 408 lesions 22(5.4%)underwent morphological changes. An increase in tumor diameter of 3mm or more was observed in 35 lesions(8.6%). There were 12 lesions(2.9%)whose final tumor diameter had reached 10mm or more. There were 3 lesions(0.7%)that developed and progressed into intramucosal cancer. In all 3 of those cases there were multiple simultaneous adenomas. These patients had a history of colorectal endoscopic treatment, and there were simultaneous adenomas over 10mm in diameter. Based on our assessment of the natural history of small colorectal adenomas followed up histologically and endoscopically, no changes toward major lesions were observed for at least 5 years. However, from 5 years onward some tumors increased in size and became malignant.

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