Boix Jaume, Lorenzo-Zúñiga Vicente, Moreno de Vega Vicente, Añaños Fidel E, Domènech Eugeni, Ojanguren Isabel, Gassull Miquel A
Endoscopy Unit, Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet s/n, 08916 Badalona, Spain.
Dig Dis Sci. 2007 Mar;52(3):840-4. doi: 10.1007/s10620-006-9617-z.
Large sessile colorectal polyps represent a treatment challenge. Nowadays there are discrepancies regarding how to proceed with them because of morbidity, the possibility of incomplete endoscopic resection, and the high possibility of a coexisting malignancy. This study was performed to determine the safety and effectiveness of endoscopic removal of sessile colorectal adenomas larger than 4 cm. Seventy-four patients with a total of 74 sessile polyps larger than 4 cm in diameter were treated endoscopically. Polyps were removed using argon plasma coagulation (APC) as an adjunct to piecemeal technique. Surgery was recommended in patients with invasive neoplasia. Patients with favorable histology (low-grade dysplasia [LDG] or high-grade dysplasia [HGD]) were followed up with monthly endoscopies untill total ablation of the lesion, and then at 3- to 6-month intervals. LGD was found in 38 patients, HGD in 24, and invasive neoplasia in the remaining 12 patients. A total of 54 patients were followed up for at least 6 months. Recurrence rate of polyps with favorable histology was 9.2% (5/54). Postpolypectomy bleeding was the only complication, observed in 10 patients (13.5%). We conclude that piecemeal polypectomy plus APC without saline injection, performed by an expert endoscopist, is a safe and effective treatment for all LGD or HGD large sessile colorectal polyps.
大型无蒂结直肠息肉是一个治疗难题。由于其发病率、内镜下切除不完全的可能性以及同时存在恶性肿瘤的高可能性，目前对于如何处理这些息肉存在分歧。本研究旨在确定内镜下切除直径大于4cm的无蒂结直肠腺瘤的安全性和有效性。74例患者共74枚直径大于4cm的无蒂息肉接受了内镜治疗。息肉采用氩离子凝固术（APC）作为分块切除技术的辅助手段进行切除。对于有浸润性肿瘤的患者建议进行手术。组织学结果良好（低级别异型增生[LGD]或高级别异型增生[HGD]）的患者每月进行内镜检查直至病变完全消融，之后每3至6个月检查一次。38例患者为LGD，24例为HGD，其余12例患者为浸润性肿瘤。共有54例患者接受了至少6个月的随访。组织学结果良好的息肉复发率为9.2%（5/54）。息肉切除术后出血是唯一的并发症，10例患者（13.5%）出现该并发症。我们得出结论，由专业内镜医师进行的不注射生理盐水的分块息肉切除术加APC，是治疗所有LGD或HGD大型无蒂结直肠息肉的一种安全有效的方法。
