Katsinelos Panagiotis, Chatzimavroudis Grigoris, Papaziogas Basilis, Zavos Christos, Paroutoglou George, Pilpilidis Ioannis, Vasiliadis Themistoklis, Kountouras Jannis
Department of Endoscopy, Central Hospital, Thessaloniki, Greece.
Surg Laparosc Endosc Percutan Tech. 2008 Feb;18(1):19-23. doi: 10.1097/SLE.0b013e3181576915.
The use of endoclipping may minimize the risk of bleeding after endoscopic polypectomy of large pedunculated polyps. The aim of this study was to assess the safety and efficacy of endoclipping of the stalk before resection of large pedunculated colorectal polyps, drawing particular attention to the cases in which the use of this method could be very useful.
This retrospective study included 17 patients [10 men, 7 women; median age: 62 y (range 38 to 79)] with 18 large pedunculated colorectal polyps, who underwent endoclipping-assisted endoscopic polypectomy between March 2003 and May 2006. The outcome of the technique and the technique-related complications were evaluated.
Application of the clips was possible in all patients. In 4 patients (23.5%), the endoclipping was performed via the more flexible gastroscope. En bloc resection of colon polyps was achieved in all patients. No immediate or late bleeding or perforation occurred. One patient (5.9%) developed postcoagulation syndrome and was successfully treated conservatively. Histologic examination showed in situ carcinoma in 6 polyps (33.3%). Follow-up colonoscopy demonstrated no recurrence of polyps or cancer development.
Endoclipping, followed by snare transection, may be safer than conventional polypectomy in large pedunculated colorectal polyps. Special attention is needed not to cut very close to clips to avoid thermal injury of colonic wall.
使用内镜夹闭术可将大的有蒂息肉内镜切除术后的出血风险降至最低。本研究的目的是评估在切除大的有蒂结直肠息肉之前对蒂部进行内镜夹闭术的安全性和有效性，尤其关注该方法可能非常有用的病例。
这项回顾性研究纳入了17例患者[10例男性，7例女性；中位年龄：62岁（范围38至79岁）]，他们有18个大的有蒂结直肠息肉，于2003年3月至2006年5月期间接受了内镜夹闭辅助内镜息肉切除术。评估了该技术的结果及与技术相关的并发症。
所有患者均可行夹子应用。4例患者（23.5%）通过更灵活的胃镜进行内镜夹闭术。所有患者均实现了结肠息肉的整块切除。未发生即刻或延迟出血或穿孔。1例患者（5.9%）发生了凝血后综合征，经保守治疗成功治愈。组织学检查显示6个息肉（33.3%）存在原位癌。随访结肠镜检查未发现息肉复发或癌症进展。
对于大的有蒂结直肠息肉，先进行内镜夹闭术再用圈套器切断可能比传统息肉切除术更安全。需要特别注意不要在靠近夹子处切割，以避免结肠壁热损伤。
