Hurlstone D P, Cross S S, Drew K, Adam I, Shorthouse A J, Brown S, Sanders D S, Lobo A J
Gastroenterology and Liver Unit, Royal Hallamshire Hospital, Sheffield, United Kingdom.
Endoscopy. 2004 Jun;36(6):491-8. doi: 10.1055/s-2004-814397.
Endoscopic mucosal resection provides an alternative to surgery for resection of sessile and flat colorectal lesions. High-magnification chromoscopic colonoscopy may allow early detection and anticipate histological diagnosis by identifying colonic crypt patterns. The aim of the present study was to assess the efficacy and safety of en-bloc endoscopic mucosal resection with high-magnification chromoendoscopy in the management of sessile and flat colorectal lesions </= 20 mm.
A single endoscopist using high-magnification chromoendoscopy prospectively examined 1000 patients attending for routine colonoscopy. Patients were selected for inclusion in the study if they were considered to be at high risk for underlying colorectal neoplasia or polyps. Within the study period, 1000 patients (29 %) qualified for entry from a total of 3480 colonoscopies conducted in our institution. Endoscopic mucosal resection was carried out in appropriate flat and sessile lesions.
Endoscopic mucosal resection was carried out in 599 lesions. Complete histological resection was confirmed in 576 (96 %). Perforation occurred in one patient (0.2 %) and bleeding in 12 (2 %). A total of 254 lesions (40 %; excluding hyperplasia/metaplasia) were flat or depressed, and 374 (60 %) were sessile. Fifty-eight flat lesions (23 %) contained high-grade dysplasia or beyond, compared to 33 sessile lesions (9.0 %; P = 0.001). After resection, 21 lesions were upgraded histologically, with 17 being defined as adenoma with high-grade dysplasia or beyond.
This study confirms that flat adenomas and carcinomas occur in the West and demonstrates the malignant potential of such lesions, which can be managed successfully using endoscopic techniques. Endoscopic mucosal resection with high-magnification chromoscopy is a safe and effective form of treatment for sessile or flat colorectal lesions. Complete resection can improve the accuracy of histopathological diagnosis. However, colonoscopists require training in these procedures in order to improve the rate of colorectal cancer detection.
内镜黏膜切除术为切除无蒂和扁平结直肠病变提供了一种替代手术的方法。高倍放大染色结肠镜检查可通过识别结肠隐窝形态实现早期检测并预测组织学诊断。本研究的目的是评估高倍放大染色内镜下整块内镜黏膜切除术治疗直径≤20mm的无蒂和扁平结直肠病变的有效性和安全性。
一名内镜医师使用高倍放大染色结肠镜对1000例行常规结肠镜检查的患者进行前瞻性检查。如果患者被认为存在潜在结直肠肿瘤或息肉的高风险，则被选入本研究。在研究期间，在我们机构进行的总共3480例结肠镜检查中，有1000例患者（29%）符合入选标准。对合适的扁平及无蒂病变进行内镜黏膜切除术。
共对599处病变进行了内镜黏膜切除术。576处（96%）病变经组织学检查证实完全切除。1例患者（0.2%）发生穿孔，12例（2%）发生出血。总共254处病变（40%；不包括增生/化生）为扁平或凹陷性病变，374处（60%）为无蒂病变。58处扁平病变（23%）含有高级别异型增生或更严重病变，相比之下，33处无蒂病变（占9.0%；P = 0.001）。切除术后，21处病变组织学升级，其中17处被定义为高级别异型增生或更严重的腺瘤。
本研究证实西方存在扁平腺瘤和癌，并证明了此类病变的恶性潜能，可通过内镜技术成功治疗。高倍放大染色内镜下的内镜黏膜切除术是治疗无蒂或扁平结直肠病变的一种安全有效的方法。完全切除可提高组织病理学诊断的准确性。然而，结肠镜医师需要接受这些操作的培训，以提高结直肠癌的检出率。
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