Wada Yoshiki, Kudo Shin-ei, Tanaka Shinji, Saito Yutaka, Iishii Hiroyasu, Ikematsu Hiroaki, Igarashi Masahiro, Saitoh Yusuke, Inoue Yuji, Kobayashi Kiyonori, Hisabe Takashi, Tsuruta Osamu, Kashida Hiroshi, Ishikawa Hideki, Sugihara Kenichi
Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, 224-8503, Japan,
Surg Endosc. 2015 May;29(5):1216-22. doi: 10.1007/s00464-014-3799-9. Epub 2014 Aug 27.
Conventional endoscopic resection (CER) includes polypectomy and endoscopic mucosal resection. The most common complications related to these techniques are post procedure bleeding and perforation. The aim of this study was to evaluate the outcomes of CER for colorectal neoplasms ≧20 mm and to clarify predictive factors for complications.
We conducted a multicenter prospective study at 18 specialized institutes. From October 2007 to December 2010, 1,029 CERs were performed at participating institutes. We collected the data prospectively and analyzed gender, age, tumor size, gross appearance, mode of resection, etc.
The mean size of polyps resected was 26.4 ± 8.6 mm (range 20-120 mm). The final pathology was Vienna classification category 1 or 2 in 24, category 3 in 502, and category 4 or 5 in 503 lesions. Post procedure bleeding and intra procedure perforation occurred, respectively, in 16 (1.6%) and 8 cases (0.78%). The overall complication rate was 2.3%. Risk factors for bleeding in multivariate analysis were only patients under 60 years of age. Risk factors for perforation in multivariate analysis were en bloc resection and Vienna classification category 4-5. The difference of complication rate was not statistically significant regarding gender, size, tumor location, gross appearance, treatment method, and kind of insufflation.
CER is a safe, efficient, and effective minimally invasive therapy for large colorectal lesions. However, care should be taken for post procedure bleeding in patients under 60 years of age and for perforation in cases of Vienna classification category 4-5 or when an en bloc resection is tried.
传统内镜切除术（CER）包括息肉切除术和内镜黏膜切除术。与这些技术相关的最常见并发症是术后出血和穿孔。本研究的目的是评估CER治疗直径≥20 mm的结直肠肿瘤的疗效，并阐明并发症的预测因素。
我们在18家专业机构进行了一项多中心前瞻性研究。2007年10月至2010年12月，参与研究的机构共进行了1029例CER。我们前瞻性地收集了数据，并分析了性别、年龄、肿瘤大小、大体外观、切除方式等。
切除息肉的平均大小为26.4±8.6 mm（范围20 - 120 mm）。最终病理结果为维也纳分类1或2类的有24例，3类的有502例，4或5类的有503例病变。术后出血和术中穿孔分别发生在16例（1.6%）和8例（0.78%）。总体并发症发生率为2.3%。多因素分析中出血的危险因素仅为60岁以下患者。多因素分析中穿孔的危险因素为整块切除和维也纳分类4 - 5类。在性别、大小、肿瘤位置、大体外观、治疗方法和充气类型方面，并发症发生率的差异无统计学意义。
CER是一种安全、高效且有效的大型结直肠病变微创治疗方法。然而，对于60岁以下患者的术后出血以及维也纳分类4 - 5类或尝试整块切除的病例的穿孔应予以关注。
