Mahadeva Sanjiv, Rembacken Bjorn J
Division of Gastroenterology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Surg Endosc. 2009 Feb;23(2):417-22. doi: 10.1007/s00464-008-9983-z. Epub 2008 Sep 20.
Standard polypectomy techniques may be contributing to ineffective eradication of colonic superficial neoplasia, an increasing number of which are nonpolypoid. We aimed to demonstrate the practicality and efficacy of the "inject and cut" endoscopic mucosal resection (EMR) technique in routine clinical practice.
Colonic EMRs performed for polypoid and nonpolypoid lesions at a tertiary institution were prospectively collected and analyzed for efficacy, and short and long-term complications.
224 colonic neoplasms (143 flat, 65 sessile and 16 subpedunculated) were excised by the standard inject-and-cut method, with standard accessories. The median size of all lesions was 10 mm (range 2-50 mm) and 110 (49.2%) lesions were located in the proximal colon. Histological completeness of resection was achieved in 87% of cases. Of the lesions 77.2% were dysplastic, with 5 cases of carcinoma in situ and 18 severely dysplastic adenomas. Complications included bleeding in five cases (2.2 %) and a single case of perforation (0.4%). All complications were managed endoscopically. Median follow up at 24 +/- 16 months (range 12-84 months) revealed a 7.2% local recurrence rate, all of which were subsequently eradicated by repeat EMR.
Standard inject-and-cut colonic EMR is practical and effective in the eradication of superficial colonic neoplasia.
标准的息肉切除术技术可能导致结肠浅表肿瘤无法有效根除，现在这类肿瘤中非息肉样的越来越多。我们旨在证明“注射切除”内镜黏膜切除术（EMR）技术在常规临床实践中的实用性和有效性。
前瞻性收集并分析了在一家三级医疗机构对息肉样和非息肉样病变进行的结肠EMR的疗效、短期和长期并发症。
采用标准注射切除法和标准附件切除了224例结肠肿瘤（143例扁平型、65例无蒂型和16例亚蒂型）。所有病变的中位大小为10毫米（范围2 - 50毫米），110例（49.2%）病变位于近端结肠。87%的病例实现了组织学完全切除。其中77.2%的病变为发育异常，5例原位癌，18例重度发育异常腺瘤。并发症包括5例出血（2.2%）和1例穿孔（0.4%）。所有并发症均通过内镜处理。中位随访时间为24±16个月（范围12 - 84个月），局部复发率为7.2%，所有复发均通过再次EMR得以根除。
标准注射切除结肠EMR在根除结肠浅表肿瘤方面实用且有效。
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