Vanagunas A, Jacob P, Vakil N
Department of Medicine, VA Lakeside Medical Center, Chicago, Illinois.
Am J Gastroenterol. 1989 Apr;84(4):383-5.
Patients with diminutive polyps in the rectum or sigmoid colon were randomized to "hot biopsy" treatment for either 1) electrocautery for 2 s (fixed duration cautery) or 2) cautery until visible necrosis of the polyp base was evident (variable duration cautery). Sigmoidoscopy was performed 4 wk after treatment to determine the adequacy of polyp eradication. In the fixed duration cautery group, 11 of 21 polyps (52%) were eradicated, compared with 12 of 14 polyps (86%) in the variable duration cautery group (p = 0.04). When analyzed according to whether or not visible necrosis was achieved (some of the polyps in the fixed duration cautery group showed necrosis with 2 s cautery), 19 of 23 polyps (83%) were eradicated when necrosis was evident, compared to 5 of 12 (42%) without necrosis (p = 0.004). We conclude that hot biopsy treatment for diminutive polyps is significantly more effective when visible necrosis is achieved during cautery. Furthermore, even with visible necrosis, there is a 17% failure rate of polyp eradication.
直肠或乙状结肠微小息肉患者被随机分为“热活检”治疗组，治疗方式为：1）电灼2秒（固定持续时间电灼）或2）电灼直至息肉基部出现明显的可见坏死（可变持续时间电灼）。治疗4周后进行乙状结肠镜检查，以确定息肉切除是否彻底。在固定持续时间电灼组中，21个息肉中有11个（52%）被切除，相比之下，可变持续时间电灼组中14个息肉中有12个（86%）被切除（p = 0.04）。根据是否实现可见坏死进行分析（固定持续时间电灼组中的一些息肉在电灼2秒时出现坏死），当出现明显坏死时，23个息肉中有19个（83%）被切除，而未出现坏死的12个息肉中有5个（42%）被切除（p = 0.004）。我们得出结论，在电灼过程中实现可见坏死时，微小息肉的热活检治疗效果显著更佳。此外，即使出现可见坏死，息肉切除的失败率仍为17%。
