대장폴립절제술 가이드라인 = Korean Guidelines for Colonoscopic Polypectomy

국문 초록 (Abstract)

1. 대장폴립절제술 전 혈전색전증 발생 고위험군에서는 아스피린 복용을 계속해야 하고, 혈전색전증 발생 저위험군에서는 환자 및 폴립의 특성에 따라 중단 여부를 결정해야 하며, 혈전 발생위험이 없는 군에서는 가능하면 아스피린을 중단하는 것이 권고된다. 2. 미소폴립의 제거에서는 완전 제거율, 안정성, 회수조직의 조직학적 적정성 여부를 고려할 때 고온 생검법은 권고되지 않는다. 3. 폴립절제술 시점막하 주사는 조기 출혈 예방에 도움이 되지만 지연 출혈 예방효과는 분명치 않다. 4. 크기가 큰(＞1 cm) 목 있는 폴립의 절제에서 절제 전예방적 시술(루프 혹은 클립 유치)은 조기 출혈의 예방에 도움이 되지만 지연 출혈의 예방효과는 분명치 않다. 5. 폴립 절제 후 생성된 인공궤양에 대한 예방적 시술(아르곤플라스마 응고술 혹은 클립 유치술)은 지연 출혈 예방에 도움이 되지 않는다. 6. 폴립절제술 후 조직검사에서 점막하 침범이 있으면서 완전절제(절제면 음성)된 선암으로 판정된 경우 림프관 혹은 정맥 침범이 있거나, 분화도가 나쁜 경우, 침범 깊이가 깊을 경우에는 림프절 전이의 위험이 증가하므로 추가적인 수술적 절제를 고려해야 한다.

다국어 초록 (Multilingual Abstract)

There are indirect evidences to suggest that 80% of colorectal cancers (CRC) develop from adenomatous polyps and that, on average, it takes 10 years for a small polyp to transform into invasive CRC. In multiple cohort studies, colonoscopic polypectomy has been shown to significantly reduce the expected incidence of CRC by 76% to 90%. Colonoscopic polypectomy is performed frequently in primary, secondary and tertiary and medical centers in Korea. However, there are no evidence-based, procedural guidelines for the appropriate performance of this procedure, including the technical aspects. For the guideline presented here, Pubmed, Medline, and Cochrane Library literature searches were performed. When little or no data from well-designed prospective trials were available, an emphasis was placed on the results from large series and reports from recognized experts. Thus, these guidelines for colonoscopic polypectomy are based on a critical review of the available data as well as expert consensus. Further controlled clinical studies are needed to clarify aspects of this statement, and revision may be necessary as new data become available. This guideline is intended to be an educational device to provide information that may assist endoscopists in providing care to patients. This guideline is not a rule and should not be construed as a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment. Clinical decisions for any particular case involve a complex analysis of the patient`s condition and the available courses of action.

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