使用双环圈套器对中大型结直肠息肉进行内镜下黏膜切除术。

Endoscopic mucosal resection for middle and large colorectal polyps with a double-loop snare.

作者信息

Yoshida Naohisa, Saito Yutaka, Hirose Ryohei, Ogiso Kiyoshi, Inada Yutaka, Yagi Nobuaki, Naito Yuji, Otake Yosuke, Nakajima Takeshi, Matsuda Takahisa, Yanagisawa Akio, Itoh Yoshito

机构信息

Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan.

出版信息

Digestion. 2014;90(4):232-9. doi: 10.1159/000368044. Epub 2014 Dec 17.

DOI:10.1159/000368044

PMID:25532080

Abstract

BACKGROUND/AIMS: This study aimed to analyze the endoscopic mucosal resection (EMR) with a novel uniquely shaped, double-loop snare (Dualoop, Medico's Hirata Inc., Tokyo, Japan) for colorectal polyps.

METHODS

This was a clinical trial conducted in two referral centers, Kyoto Prefectural University of Medicine and National Cancer Center Hospital in Japan. First, the firmness of various snares including 'Dualoop' was experimentally analyzed with a pressure gauge. Five hundred and eighty nine consecutive polyps that underwent EMR with 'Dualoop' were compared to 339 polyps with the standard round snare. Lesion characteristics, en bloc resection, and complications were analyzed.

RESULTS

'Dualoop' had the most firmness among the various snares. The average tumor size was 9.3 mm (5-30), and en bloc resection was achieved in 95.4%. The rate of en bloc resection for middle polyps 15-19 mm in diameter was significantly higher with the 'Dualoop' than that with the round snare (97.9 vs. 80.0%, p < 0.05). The rate of en bloc resection was 64.7% for large polyps ≥20 mm in diameter using 'Dualoop'. Higher age, larger tumor size, and superficial polyps were associated with the failure of en bloc resection.

CONCLUSION

EMR with 'Dualoop' was effective for resecting both middle and large polyps en-bloc.

摘要

背景/目的：本研究旨在分析使用一种新型独特形状的双环圈套器（Dualoop，日本东京Medico's Hirata公司）进行内镜黏膜切除术（EMR）治疗大肠息肉的效果。

方法

这是一项在日本京都府立医科大学和国立癌症中心医院这两个转诊中心进行的临床试验。首先，使用压力计对包括“Dualoop”在内的各种圈套器的坚固性进行实验分析。将连续589例使用“Dualoop”进行EMR的息肉与339例使用标准圆形圈套器的息肉进行比较。分析病变特征、整块切除情况及并发症。

结果

“Dualoop”在各种圈套器中坚固性最强。平均肿瘤大小为9.3毫米（5 - 30毫米），整块切除率达95.4%。对于直径15 - 19毫米的中等大小息肉，“Dualoop”的整块切除率显著高于圆形圈套器（97.9%对80.0%，p < 0.05）。使用“Dualoop”对直径≥20毫米的大息肉进行整块切除的比率为64.7%。年龄较大、肿瘤尺寸较大及息肉表浅与整块切除失败相关。