Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, United Kingdom.
Endoscopy. 2016 Mar;48(3):277-80. doi: 10.1055/s-0035-1569647. Epub 2016 Jan 28.
There have been significant advances in the management of complex colorectal polyps. Previous failed resection or polyp recurrence is associated with significant fibrosis, making endoscopic resection extremely challenging; the traditional approach to these lesions is surgery. The aim of this study was to evaluate the efficacy of a novel, knife-assisted snare resection (KAR) technique in the resection of scarred colonic polyps.
This was a prospective cohort study of patients, in whom the KAR technique was used to resect scarred colonic polyps > 2 cm in size. Patients had previously undergone endoscopic mucosal resection (EMR) and developed recurrence, or EMR had been attempted but was aborted as a result of technical difficulty.
A total of 42 patients underwent KAR of large (median 40 mm) scarred polyps. Surgery for benign disease was avoided in 38 of 41 patients (93 %). No life-threatening complications occurred. Recurrence was seen in six patients (16 %), five of whom underwent further endoscopic resection. The overall cure rate for KAR in complex scarred colonic polyps was 90 %.
KAR of scarred colonic polyps by an expert endoscopist was an effective and safe technique with low recurrence rates.
复杂结直肠息肉的治疗已有显著进展。既往切除失败或息肉复发与显著纤维化相关，使内镜下切除极具挑战性；这些病变的传统治疗方法为手术。本研究旨在评估一种新型的、刀辅助圈套切除术（KAR）技术在切除瘢痕性结肠息肉中的疗效。
这是一项前瞻性队列研究，纳入 KAR 技术切除＞2cm 大小的瘢痕性结肠息肉患者。这些患者既往接受过内镜黏膜切除术（EMR）且复发，或因技术难度而尝试 EMR 但失败。
共 42 例患者接受了 KAR 治疗大（中位数 40mm）瘢痕性息肉。41 例患者中的 38 例（93%）避免了良性疾病手术。未发生危及生命的并发症。6 例患者（16%）出现复发，其中 5 例接受了进一步的内镜下切除。KAR 治疗复杂瘢痕性结肠息肉的总体治愈率为 90%。
由经验丰富的内镜医生施行 KAR 治疗瘢痕性结肠息肉是一种有效且安全的技术，复发率低。
