Ngamruengphong Saowanee, Pohl Heiko, Haito-Chavez Yamile, Khashab Mouen A
Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, 1800 Orleans Street, Zayed Bldg, Suite 7125B, Baltimore, MD, 21287, USA.
Department of Gastroenterology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
Curr Gastroenterol Rep. 2016 Jan;18(1):3. doi: 10.1007/s11894-015-0476-7.
Endoscopists often encounter colon polyps that are technically difficult to resect. These lesions traditionally were managed surgically, with significant potential morbidity and mortality. Recent advances in endoscopic techniques and instruments have allowed endoscopists to safely and effectively remove colorectal lesions with high technical and clinical success and potentially avoid invasive surgery. Endoscopic mucosal resection (EMR) has gained acceptance as the first-line therapy for large colorectal lesions. Endoscopic submucosal dissection (ESD) has been reported to be associated with higher rate of en bloc resection and less risk of short-time recurrence, but with an increased risk of adverse events. Therefore, the role of colorectal ESD should be restricted to lesions with high-risk morphologic features of submucosal invasion. In this article, we review the recent literature on the endoscopic management of difficult colorectal neoplasms.
内镜医师经常会遇到技术上难以切除的结肠息肉。这些病变传统上通过手术处理，存在显著的发病和死亡风险。内镜技术和器械的最新进展使内镜医师能够安全有效地切除结直肠病变，在技术和临床方面都取得了很高的成功率，并有可能避免侵入性手术。内镜黏膜切除术（EMR）已被广泛接受为大型结直肠病变的一线治疗方法。据报道，内镜黏膜下剥离术（ESD）整块切除率更高，短期复发风险更低，但不良事件风险增加。因此，结直肠ESD的应用应限于具有黏膜下浸润高危形态学特征的病变。在本文中，我们回顾了关于难处理结直肠肿瘤内镜治疗的最新文献。
