用于结肠肿瘤性病变管理的SMSA分级工具的临床效用。
Clinical utility of the SMSA grading tool for the management of colonic neoplastic lesions.
作者信息
Sansone Stefano, Ragunath Krish, Bianco Maria Antonia, Manguso Francesco, Beg Sabina, Bagewadi Abhay, Din Said, Rotondano Gianluca
机构信息
Gastroenterology, Hospital Maresca, ASLNA3sud, Torre del Greco, Italy; NIHR Nottingham Digestive Diseases Biomedical Research Unit, Queens Medical Centre, Nottingham University Hospitals NHS Trust, UK.
NIHR Nottingham Digestive Diseases Biomedical Research Unit, Queens Medical Centre, Nottingham University Hospitals NHS Trust, UK.
出版信息
Dig Liver Dis. 2017 May;49(5):518-522. doi: 10.1016/j.dld.2016.12.030. Epub 2017 Jan 6.
BACKGROUND
Whilst polyp size has been traditionally used as a predictor of the complexity of endoscopic resection, the influence of other factors is increasingly recognised. The SMSA grading system takes into account polyp Site, Morphology, Size and Access, with higher scores correlating with increased technical difficulty.
AIMS
To evaluate whether the SMSA grading tool correlates with endoscopic and clinical outcomes.
METHODS
This retrospective study was conducted at two high volume centres in the United Kingdom and Italy. All polyps identified at colonoscopy were included in this study and classified as per the SMSA grading system.
RESULTS
A total of 1668 lesions were resected in 1016 patients. There was a positive correlation between increasing SMSA level and the inability to resect lesions "en bloc" (p<0.001). Histologically complete clearance was higher in the lower SMSA groups (p<0.0001). Additional endoscopic therapies, were more commonly required with the higher SMSA groups to achieve histological clearance (p<0.0001). Moreover, advanced histology in resection specimens and procedural complications were significantly less common in SMSA level 1 lesions compared to level 3 or 4 lesions (p<0.0001).
CONCLUSIONS
The SMSA grading tool is a useful predictor of outcome following the resection of colonic neoplastic lesions.
背景
虽然息肉大小传统上被用作内镜切除复杂性的预测指标，但其他因素的影响也越来越受到认可。SM SA分级系统考虑了息肉的部位、形态、大小和可达性，分数越高，技术难度越大。
目的
评估SM SA分级工具是否与内镜及临床结果相关。
方法
这项回顾性研究在英国和意大利的两个高容量中心进行。结肠镜检查中发现的所有息肉均纳入本研究，并根据SM SA分级系统进行分类。
结果
1016例患者共切除1668个病变。SM SA分级水平升高与无法“整块”切除病变之间存在正相关（p<0.001）。较低SM SA组的组织学完全清除率更高（p<0.0001）。较高SM SA组更常需要额外的内镜治疗以实现组织学清除（p<0.0001）。此外，与3级或4级病变相比，SM SA 1级病变切除标本中的高级别组织学和手术并发症明显较少见（p<0.0001）。
结论
SM SA分级工具是结肠肿瘤性病变切除术后结果的有用预测指标。
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