内镜下黏膜切除术治疗大肠广基息肉并黏膜下注射50%高渗葡萄糖-肾上腺素溶液

Endoscopic mucosal resection of large sessile colorectal polyps with submucosal injection of hypertonic 50 percent dextrose-epinephrine solution.

作者信息

Katsinelos Panagiotis, Kountouras Jannis, Paroutoglou George, Zavos Christos, Rizos Christos, Beltsis Athanasios

机构信息

Department of Endoscopy and Motility Unit, Central Hospital, Thessaloniki, Macedonia 551 33, Greece.

出版信息

Dis Colon Rectum. 2006 Sep;49(9):1384-92. doi: 10.1007/s10350-006-0611-5.

DOI:10.1007/s10350-006-0611-5

PMID:16897333

Abstract

PURPOSE

Before endoscopic mucosal resection of large sessile colorectal polyps, injection of solution into submucosa cushions and isolates the tumor, although there is little information as to which solution with optimal effect should be used. This study investigated the effectiveness of endoscopic mucosal resection by use of a hypertonic dextrose plus epinephrine solution for large sessile colorectal polyps.

METHODS

We removed 59 large sessile colorectal polyps in 59 patients by introducing an endoscopic submucosal hypertonic dextrose plus epinephrine injection technique. Endoscopic evaluations were repeated at 3, 6, and 12 months or longer. If no residual tumor was observed endoscopically and histologically at one year or more, the patient was considered to be "cured." The main outcome measurements were the mean amount of solution injected, mean disappearance time of solution, safety, complications, and recurrence at follow-up.

RESULTS

Of the 59 large sessile colorectal polyps, 23 (39 percent) were resected en bloc and 36 (61 percent) piecemeal. The mean amount of hypertonic dextrose plus epinephrine solution injected was 24.42 +/- 17.52 ml, and its mean disappearance time was 13.61 +/- 5.21 (range, 7-21) minutes. Of the 36 patients treated with piecemeal resection, 18 (50 percent) required additional endoscopic interventions. In patients who entered the follow-up surveillance protocol for one year or longer, the cure rate by en bloc resection was 100 percent (23/23) and that by piecemeal intervention was 96.78 percent (30/31). Four patients (6.8 percent) had local bleeding after endoscopic mucosal resection that was mainly controlled endoscopically.

CONCLUSIONS

Endoscopic mucosal resection after submucosal hypertonic dextrose plus epinephrine solution injection, with an intensive follow-up program, seems to be a safe and effective treatment for large sessile colorectal polyps.

摘要

目的

在内镜下黏膜切除大型广基结直肠息肉之前，向黏膜下层注射溶液以垫起并分离肿瘤，然而关于应使用哪种具有最佳效果的溶液的信息较少。本研究调查了使用高渗葡萄糖加肾上腺素溶液进行内镜下黏膜切除治疗大型广基结直肠息肉的有效性。

方法

我们采用内镜下黏膜下高渗葡萄糖加肾上腺素注射技术，为59例患者切除了59个大型广基结直肠息肉。在3、6和12个月或更长时间重复进行内镜评估。如果在一年或更长时间内镜及组织学检查未发现残留肿瘤，则该患者被视为“治愈”。主要观察指标为注射溶液的平均量、溶液的平均消失时间、安全性、并发症及随访时的复发情况。

结果

59个大型广基结直肠息肉中，23个（39%）整块切除，36个（61%）分块切除。高渗葡萄糖加肾上腺素溶液的平均注射量为24.42±17.52 ml，其平均消失时间为13.61±5.21（范围7 - 21）分钟。在36例接受分块切除的患者中，18例（50%）需要额外的内镜干预。进入一年或更长时间随访监测方案的患者中，整块切除的治愈率为100%（23/23），分块干预的治愈率为96.78%（30/31）。4例患者（6.8%）在内镜下黏膜切除术后出现局部出血，主要通过内镜控制。