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Polype minuscule de moins de 6 mm ou minuscule polype en 2012

Polyps of less than 6 mm or tiny polyps in 2012

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  • Published:
Acta Endoscopica

Résumé

Le polype de moins de 6 mm ou minuscule polype (≤ 5 mm) représente la moitié des polypes, et une fois sur deux est un adénome. La présence de lésions histologiquement avancées est rare et la présence de carcinomes, intramuqueux ou invasifs, nulle ou exceptionnelle. Le potentiel évolutif de ces lésions de moins de 6 mm est peu décrit ou sans augmentation de leur taille après un suivi court de deux-trois ans. Leur diagnostic est délicat avec près d’un quart de faux-négatifs en vidéocoloscopie. Le rendement pour leur diagnostic par l’endoscopie à bande spectrale étroite, autofluorescence, capuchon distal ne permet pas de diminuer leur taux d’omission. Le diagnostic de leur nature adénomateuse ou non néoplasique par ces technologies n’est pas actuellement usuel en pratique quotidienne. Ces méthodes ou leur association sont en évaluation dans des centres experts. Cependant, la méthode la plus répandue, l’endoscopie à bande spectrale étroite (NBI ou FICE ou I-Scan), permet de diagnostiquer leur nature néoplasique avec une précision d’environ 90 %. Leur exérèse avec ou sans analyse histologique doit être totale, et la biopsie-exérèse à la pince froide ne remplit pas ces conditions. Ce type d’ablation est générateur de résidus adénomateux dans 20 à 30 % des cas. La préparation colique de mauvaise qualité est pourvoyeuse de faux-négatifs, mais il n’existe pas d’argument pour attribuer le caractère protecteur incomplet de la coloscopie spécifiquement à l’omission du polype inférieur ou égal à 5 mm. L’attitude consistant à réséquer ces polypes sans les analyser est pourvoyeuse d’une économie notable, mais la preuve de l’innocuité de cette stratégie n’est pas prospectivement démontrée. Les considérations économiques sont très discordantes du fait du caractère partiel et faible des fréquences ou incidences des polypes de moins de 5 mm à haut risque et des modélisations qui ne sont que des études de minimisation des coûts et non pas des études de coût-efficacité à long terme.

Abstract

Polyps measuring less than 6 mm or tiny polyps (≤ 5 mm) represent half of all polyps and one in every two is an adenoma. The presence of histologically advanced lesions is rare and the presence of intramucous or invasive carcinomas is non-existent or exceptional. The progressive potential of these lesions measuring less than 6 mm is either poorly described or there is no increase in size after a short follow-up period of two/three years. Their diagnosis is tricky with nearly a quarter being falsely diagnosed as negative during video colonoscopy. The success rate for their diagnosis using a narrow spectral band endoscopy, autofluorescence or a distal cap does not reduce the omission rate. These techniques are not commonly used on a day-to-day basis for the diagnosis of the adenomatous or non-neoplastic nature of the polyps. These methods and their concomitant use are being evaluated in specialist centres. However, the most widespread method, the narrow spectral band endoscopy (NBI or FICE or I-Scan), permits the diagnosis of the neoplastic nature of polyps with around 90% accuracy. Their excision with or without histological analysis must be total and excision/biopsy with a cold clamp does not meet these conditions. This type of excision generates adenomatous residues in 20 to 30% of cases. Poor bowel preparation can be the source of false-negatives but there is no argument to attribute the incomplete protective nature of the colonoscopy specifically to the omission of ≤ 5 mm polyps. The practice of resecting these polyps without analysing them can result in substantial savings but proof of there being no long-term damage as a result of this strategy is yet to be provided. Financial considerations are very discordant because of the infrequent incidences of high-risk polyps of less than 5 mm and the establishment of patterns that only examine how to reduce costs rather than long-term cost effectiveness.

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    D. Heresbach

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Heresbach, D. Polype minuscule de moins de 6 mm ou minuscule polype en 2012. Acta Endosc 42, 164–185 (2012). https://doi.org/10.1007/s10190-012-0261-5

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