Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia.
Gastrointest Endosc. 2011 Jan;73(1):79-85. doi: 10.1016/j.gie.2010.07.003.
EMR of large sessile polyps and laterally spreading tumors (LSTs) of the colon is safe and cost-effective. Perforation remains a feared and well-recognized complication; however, endoscopic detection is often absent, and most commonly, diagnosis is delayed and depends on clinical signs and/or radiology findings. To date, an endoscopic sign to identify muscularis propria (MP) resection and potential perforation has not been described.
To describe an endoscopic sign for prompt recognition of EMR-related MP resection.
Prospective analysis.
Tertiary referral academic gastroenterology unit.
Patients with the target sign were identified prospectively in 2 large prospective studies of EMR for colonic LSTs 20 mm or larger.
A standardized EMR approach was used. MP defects were closed endoscopically with clips.
The presence or absence of the target sign in the polypectomy specimen and its influence on subsequent endoscopic management of polypectomy complications.
A total of 445 patients with LSTs or sessile polyps 20 mm or larger (mean size 33 mm, range 20-85 mm) were prospectively enrolled in 2 studies. Ten patients (mean age 70.3 years, range 48-83 years, 50% male) with target lesions and histologically confirmed MP resection were identified prospectively at the time of EMR, with 3 having full-thickness resection. All cases were identified intraprocedurally by a target sign on the underside of the specimen and a mirror target evident in the mucosal defect. All patients were treated endoscopically with 1 to 5 endoscopic clips. None required operative management. Thirteen inpatient days were required to treat the 10 patients (mean 1.3 days).
Nonrandomized study.
Careful analysis of the post-EMR specimen and resection defect may reveal a target sign, an easily recognized and reliable marker of either partial- or full-thickness MP resection and potential perforation. Prompt recognition of this sign facilitates endoscopic management.
对结肠的大型无蒂息肉和侧向扩展肿瘤（LST）进行 EMR 是安全且具有成本效益的。穿孔仍然是一种令人恐惧且广为人知的并发症；然而，内镜检测通常不存在，最常见的是诊断延迟且依赖于临床症状和/或放射学发现。迄今为止，还没有描述一种用于识别固有肌层（MP）切除和潜在穿孔的内镜征象。
描述一种用于快速识别与 EMR 相关的 MP 切除的内镜征象。
前瞻性分析。
三级转诊学术胃肠病学单位。
在对结肠 LST 大于等于 20mm 的 2 项大型前瞻性 EMR 研究中，前瞻性地识别出具有目标征象的患者。
使用标准化的 EMR 方法。MP 缺损用夹闭进行内镜下闭合。
在息肉切除标本中是否存在目标征象及其对息肉切除并发症后续内镜处理的影响。
在 2 项研究中，共有 445 名 LST 或无蒂息肉大于等于 20mm（平均大小为 33mm，范围 20-85mm）的患者被前瞻性纳入。在 EMR 时，前瞻性地识别出 10 名（平均年龄 70.3 岁，范围 48-83 岁，50%为男性）具有目标病变和组织学证实的 MP 切除的患者，其中 3 例为全层切除。所有病例均在手术过程中通过标本下的目标征象和黏膜缺损中的镜像目标来识别。所有患者均接受 1 至 5 个内镜夹治疗。无需要手术治疗的病例。10 名患者共需要 13 天住院治疗（平均 1.3 天）。
非随机研究。
仔细分析 EMR 后的标本和切除缺损可能会发现目标征象，这是一种易于识别且可靠的固有肌层部分或全层切除和潜在穿孔的标志物。及时识别这一征象有助于内镜治疗。
