Department of Gastroenterology, Cochin Teaching Hospital AP-HP, Paris, France.
Surg Endosc. 2013 Aug;27(8):2775-81. doi: 10.1007/s00464-013-2807-9. Epub 2013 Feb 13.
Endoscopic mucosal resection (EMR) is an efficacious endoscopic therapy for large adenoma or confined neoplasia. The most frequent complication is delayed hemorrhage, and hemoclips appear to be an effective therapeutic option. The aim of this study was to determine if large EMR could allow ambulatory management.
Colorectal polyps ≥20 mm in size treated by EMR in one endoscopy unit were prospectively included. The period from September 2007 to September 2008 was considered as the reference period (period 1). From September 2008 on, patients were hospitalized in an ambulatory unit. Periods from September 2008 to September 2009 (period 2), from September 2009 to September 2010 (period 3), and from September 2010 to September 2011 (period 4) were compared to the reference period. Patients receiving anticoagulation drugs were excluded from the study.
A total of 138 patients were treated by 139 EMRs for large colorectal polyps. EMRs were completed by at least one clip per centimeter in 10.7 %, 30.2 % (p = NS), 50 % (p = 0.015), and 76 % (p = 0.001). Ambulatory EMRs were performed in 21 %, 52.4 % (p = 0.008), 67.6 % (p = 0.02), and 88.2 % (p = 0.004) of cases during periods 1, 2, 3, and 4. The complication rate was stable during the four periods. No patients with more than one hemoclip per EMR centimeter experienced delayed bleeding.
The low complication rate during the four periods allows us to consider ambulatory EMR for large colorectal lesions ≥20 mm in diameter as an option. One hemoclip per centimeter may help prevent delayed hemorrhage in patients without anticoagulation drugs.
内镜黏膜切除术（EMR）是一种有效的内镜治疗方法，适用于大型腺瘤或局限性肿瘤。最常见的并发症是延迟性出血，而止血夹似乎是一种有效的治疗选择。本研究旨在确定是否可以对大的 EMR 进行门诊管理。
在一个内镜科室中对直径≥20mm 的大肠息肉进行 EMR 治疗，前瞻性地纳入研究。2007 年 9 月至 2008 年 9 月为参考期（第 1 期）。自 2008 年 9 月起，患者在一个门诊病房住院。比较 2008 年 9 月至 2009 年 9 月（第 2 期）、2009 年 9 月至 2010 年 9 月（第 3 期）和 2010 年 9 月至 2011 年 9 月（第 4 期）与参考期的结果。排除接受抗凝药物治疗的患者。
共 138 例患者因大肠大型息肉行 139 例 EMR 治疗。至少用一个夹子封闭每厘米的 EMR 占 10.7%、30.2%（p=NS）、50%（p=0.015）和 76%（p=0.001）。第 1、2、3 和 4 期，门诊 EMR 分别为 21%、52.4%（p=0.008）、67.6%（p=0.02）和 88.2%（p=0.004）。在四个时期，并发症发生率均保持稳定。在没有使用抗凝药物的患者中，每厘米 EMR 使用一个夹子不会发生延迟性出血。
四个时期的低并发症发生率使我们可以考虑对直径≥20mm 的大肠大型病变进行门诊 EMR 治疗。在没有抗凝药物的患者中，每厘米使用一个夹子可能有助于预防延迟性出血。
