Shouldhotbiopsyforcepsbeabandonedforpolypectomyofdiminutivecolorectalpolyps?

摘要： Standardizedapproachtopolypectomyofdiminutivecolorectalpolyps(DCPs)islackingsincecoldbiopsyforcepshavebeenassociatedwithhighlevelsofrecurrence,hotbiopsyforcepsareconsideredinadequateandriskyandcoldsnaringiscurrentlyunderinvestigationforitsefficacyandsafety.Thishasledtoconfusionandagapinclinicalpractice.ThisarticlediscussestheusefulnessandcontemporarypracticalapplicabilityofhotbiopsyforcepsandprovideswellintentionedcriticismofthenewEuropeanguidelinesforthetreatmentofDCPs.Diminutivecolorectalpolypsareasourceoffrustrationfortheendoscopistsincetheirsmallsizeisaccompaniedbyaconsiderableriskofpremalignantneoplasiaandasmallbutnonnegligibleriskofadvancedneoplasiaandevencancer.Sincetheproportionofdiminutivecolorectalpolypsissubstantialandexceedsthatoflargerpolyps,theireffectiveremovalposesaconsiderableworkloadandatherapeuticchallenge.Duringthelastdecade,theintroductionofcoldsnaringtoroutineendoscopypracticehasattemptedtoovercometheuseofpriortechniques,suchashotbiopsyforceps.Itisimportanttorecognizethatwiththeexceptionofendoscopicmethodsthatareobviouslyunsafeandinadequatetoservetheirpurpose,allotherinterventionalendoscopicmethodsareoperator-dependentinthesensethatspecificexpertiseandtrainingareobligatoryforthesuccessofanytherapeuticintervention.Sincerelevantpublicationsonhotbiopsyforcepsarestillinfavorofitscarefuluse,asithasnotyetdemonstratedinferioritycomparedwithnewertechniques,itwouldbeprudentforanymedicalpractitionertoevaluatetheavailabletoolsandjudgeanynewproposedtechniquebasedontheevidencebeforeitisadopted. （共4頁）