Overhiser Andrew J, Rex Douglas K
Department of Medicine, Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Clin Gastroenterol Hepatol. 2007 Sep;5(9):1076-9. doi: 10.1016/j.cgh.2007.04.022. Epub 2007 Jul 10.
BACKGROUND & AIMS: Large sessile colon polyps often are referred for surgical resection, even when amenable to endoscopic resection. The aim of this study was to describe the resource use of endoscopic resection of large sessile colon polyps compared with small polyps with respect to physician time and equipment use.
Retrospectively, procedure time, medication use, and equipment use were recorded for 184 consecutive patients with sessile colorectal polyps 2 cm or larger in size and for 184 consecutive control patients with only sessile polyps less than 2 cm in size or pedunculated polyps.
The mean duration of colonoscopy in patients with large sessile colon polyps averaged 51.4 (SD, 25.6) minutes compared with 20.0 (SD, 8.6) minutes for the control group (P < .0001). The large-polyp group required much more equipment to complete the polypectomy (eg, injection catheters and cautery probes) (P < .0001).
Our results indicate that the costs of endoscopic large sessile adenoma resection in physician work and equipment are substantially greater than the costs of resection of small adenomas. These costs may be a deterrent to endoscopic resection of large sessile adenomas and may warrant increased reimbursement for those procedures, particularly if predictions that colonoscopic procedures will become more complex in the future are realized.
大型无蒂结肠息肉即便适合内镜切除，通常也会被转诊进行手术切除。本研究旨在比较大型无蒂结肠息肉与小型息肉在内镜切除方面医生时间和设备使用的资源利用情况。
回顾性记录了连续184例大小为2厘米或更大的无蒂结直肠息肉患者以及连续184例仅有无蒂息肉小于2厘米或有蒂息肉的对照患者的手术时间、药物使用情况和设备使用情况。
大型无蒂结肠息肉患者的结肠镜检查平均时长为5至1.4（标准差25.6）分钟，而对照组为20.0（标准差8.6）分钟（P < 0.0001）。大型息肉组完成息肉切除术需要更多设备（如注射导管和电灼探头）（P < 0.0001）。
我们的结果表明，内镜下大型无蒂腺瘤切除在医生工作和设备方面的成本远高于小型腺瘤切除的成本。这些成本可能会阻碍大型无蒂腺瘤的内镜切除，可能需要提高这些手术的报销额度，特别是如果未来结肠镜检查程序会变得更加复杂的预测得以实现。
