Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.
Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands.
United European Gastroenterol J. 2014 Dec;2(6):497-504. doi: 10.1177/2050640614554218.
Endoscopic mucosal resection (EMR) of large rectal adenomas is largely being centralized. We assessed the safety and effectiveness of EMR in the rectum in a collaboration of 15 Dutch hospitals.
Prospective, observational study of patients with rectal adenomas >3 cm, resected by piecemeal EMR. Endoscopic treatment of adenoma remnants at 3 months was considered part of the intervention strategy. Outcomes included recurrence after 6, 12 and 24 months and morbidity.
Sixty-four patients (50% male, age 69 ± 11, 96% ASA 1/2) presented with 65 adenomas (diameter 46 ± 17 mm, distance ab ano 4.5 cm (IQR 1-8), 6% recurrent lesion). Sixty-two procedures (97%) were technically successful. Histopathology revealed invasive carcinoma in three patients (5%), who were excluded from effectiveness analyses. At 3 months' follow-up, 10 patients showed adenoma remnants. Recurrence was diagnosed in 16 patients during follow-up (recurrence rate 25%). Fifteen of 64 patients (23%) experienced 17 postprocedural complications.
In a multicenter collaboration, EMR was feasible in 97% of patients. Recurrence and postprocedural morbidity rates were 25% and 23%. Our results demonstrate the outcomes of EMR in the absence of tertiary referral centers.
内镜下黏膜切除术（EMR）对大型直肠腺瘤的治疗正在集中进行。我们评估了 15 家荷兰医院合作中直肠 EMR 的安全性和有效性。
对>3cm 的直肠腺瘤患者进行前瞻性、观察性研究，采用分片 EMR 切除。3 个月时内镜治疗腺瘤残余物被认为是干预策略的一部分。主要结局包括 6、12 和 24 个月后的复发率和发病率。
64 例患者（50%为男性，年龄 69±11 岁，96%ASA 1/2 级）共存在 65 个腺瘤（直径 46±17mm，肛缘距离 4.5cm（IQR 1-8），6%为复发病灶）。62 例（97%）手术技术成功。3 例患者（5%）病理显示浸润性癌，被排除在有效性分析之外。在 3 个月的随访中，10 例患者存在腺瘤残余。在随访期间，16 例患者被诊断为复发（复发率 25%）。64 例患者中有 15 例（23%）发生了 17 例术后并发症。
在多中心合作中，97%的患者可行 EMR。复发和术后发病率分别为 25%和 23%。我们的结果表明，在没有三级转诊中心的情况下，EMR 的治疗效果良好。
