Nottingham Digestive Diseases Centre and NIHR Biomedical Research Unit, Queens Medical Centre Campus, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK.
Dig Dis Sci. 2011 Aug;56(8):2389-95. doi: 10.1007/s10620-011-1609-y. Epub 2011 Feb 16.
Endoscopic mucosal resection (EMR) is used for treatment of sessile and flat colonic adenomas. There is limited data comparing polyp recurrence between piecemeal and en-bloc resections.
The purpose of this study was to evaluate the incidence density and predictive factors for polyp recurrence after piecemeal and en-bloc resections.
Patients undergoing EMR of flat or sessile adenomas≥10 mm were included. Incidence density (ID) and incidence rate ratio (IRR) of polyp recurrence were calculated. Predictive factors for recurrence were assessed by multivariate analysis using logistic regression.
A total of 105 patients (males 54, mean age 68) with 121 polyps were included. Sixty-seven polyps (mean size±SD, 23.3±9.2 mm) were resected piecemeal and 54 polyps (mean size 14.7±5.1 mm) were resected en-bloc. There were 12 recurrences in the piecemeal group and two in the en-bloc group. The ID of polyp recurrence in the piecemeal group was 13.1 (95% CI 7.43-23.03) and in the en-bloc group was 2.7 (95% CI 0.67-10.78) per 100 person-years of follow-up. Piecemeal resections were 5.5 (95% CI 1.1-30.48, P=0.045) times and flat polyps were 6.6 (95% CI 1.22-35.53, P=0.028) times more likely to result in recurrence compared to en-bloc resections and sessile polyps, respectively. In the piecemeal group, additional use of argon plasma coagulation (APC) did not affect the recurrence (OR 0.46, P=0.29).
Piecemeal resections and flat polyps are associated with higher recurrence following EMR. Additional use of APC did not affect the recurrence rates after piecemeal resection.
内镜黏膜切除术（EMR）用于治疗息肉样和扁平结直肠腺瘤。关于分片切除与整块切除的息肉复发率比较，相关数据有限。
本研究旨在评估分片切除与整块切除后息肉复发的发生率密度和预测因素。
纳入行 EMR 治疗的直径≥10mm 的扁平或息肉样腺瘤患者。计算息肉复发的发生率密度（ID）和复发率比值（IRR）。采用多变量 logistic 回归分析评估复发的预测因素。
共纳入 105 例（男 54 例，平均年龄 68 岁）患者的 121 个息肉。67 个息肉（平均大小±标准差，23.3±9.2mm）行分片切除，54 个息肉（平均大小 14.7±5.1mm）行整块切除。分片切除组有 12 个息肉复发，整块切除组有 2 个息肉复发。分片切除组的息肉复发 ID 为 13.1（95%CI7.43-23.03），整块切除组为 2.7（95%CI0.67-10.78）/100 人-年。与整块切除相比，分片切除的复发风险高 5.5 倍（95%CI1.1-30.48，P=0.045），扁平息肉的复发风险高 6.6 倍（95%CI1.22-35.53，P=0.028）。在分片切除组中，额外使用氩等离子凝固术（APC）不会影响复发（OR0.46，P=0.29）。
分片切除和扁平息肉与 EMR 后较高的复发率相关。APC 的额外使用并不会影响分片切除后的复发率。
