内镜黏膜下消融术：一种新的氩等离子体凝固/注射技术，可辅助完整切除复发性纤维结肠息肉（附视频）。
Endoscopic mucosal ablation: a new argon plasma coagulation/injection technique to assist complete resection of recurrent, fibrotic colon polyps (with video).
机构信息
Wolfson Unit for Endoscopy, St. Mark's Hospital and Academic Institute, Imperial College London, Watford Road, London, HA1 3UJ United Kingdom.
出版信息
Gastrointest Endosc. 2012 Feb;75(2):400-4. doi: 10.1016/j.gie.2011.09.003. Epub 2011 Dec 7.
BACKGROUND
Incomplete piecemeal EMR of large, sessile/flat colon polyps results in polyp recurrence, with massive submucosal scarring making subsequent attempts at endoscopic resection problematic.
OBJECTIVE
We report our experience with a new endoscopic mucosal ablation (EMA) technique that can be used to complement the eradication of recurrent fibrotic colon polyps.
DESIGN
Single-center, retrospective case series.
SETTING
Tertiary-care referral academic endoscopy unit.
PATIENTS
This study involved consecutive patients referred for endoscopic excision of recurrent benign colon polyps with severe submucosal fibrosis (>30% of the entire lesion).
INTERVENTION
Application of high-power argon plasma coagulation (APC), preceded by injection of a submucosal fluid cushion (normal saline/diluted adrenaline and/or sodium hyaluronate solution) to protect the muscle layer, was performed to augment further piecemeal EMR and polyp eradication.
MAIN OUTCOME MEASUREMENTS
Technical safety and success, complication and recurrence rates.
RESULTS
Fourteen patients (mean age 73 years; 9 men, 5 women) with 15 recurrent colon adenomas (mean polyp size 30 mm, 9 proximal/6 distal) were included. EMA with a mean APC power setting of 55 W was applied. Complete polyp eradication was achieved in 9 of 11 patients (82%) at first or second completed follow-up. One patient needed laparoscopic colectomy because of cancer, and 1 underwent transanal endoscopic microsurgery for benign massive recurrence. The other 3 patients with small, easily treatable recurrence (≤3 mm) were followed by 1-year-surveillance. No perforations and no postpolypectomy syndrome were reported.
LIMITATIONS
Single-center, nonrandomized case series with short duration follow-up.
CONCLUSION
EMA appears to be a safe and easily applicable technique to assist the complete eradication of recurrent fibrotic colon polyps.
背景
大块无蒂/扁平结肠息肉的不完全分片式 EMR 会导致息肉复发，大量黏膜下瘢痕形成使得随后进行内镜切除变得困难。
目的
我们报告一种新的内镜黏膜消融（EMA）技术的经验，该技术可用于补充复发性纤维性结肠息肉的根除。
设计
单中心、回顾性病例系列。
设置
三级转诊学术内镜单位。
患者
这项研究涉及连续就诊的患者，这些患者因有严重黏膜下纤维化（>整个病变的 30%）而接受内镜切除复发性良性结肠息肉。
干预
在注射黏膜下液垫（生理盐水/稀释肾上腺素和/或透明质酸钠溶液）以保护肌肉层之前，应用高能氩等离子体凝固（APC），以进一步进行分片式 EMR 和息肉消除。
主要观察指标
技术安全性和成功率、并发症和复发率。
结果
纳入 14 例（平均年龄 73 岁；9 名男性，5 名女性）患者的 15 个复发性结肠腺瘤（平均息肉大小 30mm，9 个近端/6 个远端）。应用平均 APC 功率设置为 55W 的 EMA。在首次或第二次完成随访时，11 例患者中的 9 例（82%）实现了完全息肉消除。1 例患者因癌症需要腹腔镜结肠切除术，1 例患者因良性巨大复发而行经肛门内镜微创手术。其他 3 例患者的复发较小（≤3mm），随访 1 年。未报告穿孔和息肉切除后综合征。
局限性
单中心、非随机病例系列，随访时间短。
结论
EMA 似乎是一种安全且易于应用的技术，可辅助完全根除复发性纤维性结肠息肉。
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