Luba Daniel, Raphael Mona, Zimmerman Dayna, Luba Joseph, Detka Jon, DiSario James
Daniel Luba, James DiSario, Monterey Bay Gastroenterology Consultants, Monterey, CA 93940, United States.
World J Gastrointest Endosc. 2017 Mar 16;9(3):133-138. doi: 10.4253/wjge.v9.i3.133.
To determine if prophylactic clipping of post-polypectomy endoscopic mucosal resection (EMR) mucosal defects of large, flat, right sided polyps prevents perforations.
IRB approved review of all colonoscopies, and prospective data collection of grasp and snare EMR performed by 2 endoscopists between January 1, 2010 and March 31, 2014 in a community ambulatory endoscopy center. The study consisted of two phases. In the first phase, all right-sided, flat polyps greater than or equal to 1.2 cm in size were removed using the grasp and snare technique. Clipping was done at the discretion of the endoscopist. In the second phase, all mucosal defects were closed using resolution clips. Phase 2 of the study was powered to detect a statistically significant difference in perforation rate with 148 EMRs, if less than or equal to 2 perforations occurred.
In phase 1 of the study, 2121 colonoscopies were performed. Seventy-five patients had 95 large polyps removed. There were 4 perforations in 95 polypectomies (4.2%). The perforations occurred in polyps ranging in size from 1.5 cm to 2.5 cm. In phase 2, there were 2464 colonoscopies performed. One hundred and sixteen patients had 151 large polyps removed, and all mucosal defects were clipped. There were no perforations ( = 0.0016). There were no post-polypectomy hemorrhages in either phase. An average of 2.15 clips were required to close the mucosal defects. The median time to perform the polypectomy and clipping was 13 min, and the median procedure duration was 40 min. Five percent of all patients undergoing colonoscopy in our community based, ambulatory endoscopy center had flat, right sided polyps greater than or equal to 1.2 cm in size.
Prophylactic clipping of the mucosal resection defect of large, right-sided, flat polyps reduces the incidence of perforation.
确定对大型、扁平、右侧息肉内镜黏膜切除术（EMR）后的黏膜缺损进行预防性夹闭是否可预防穿孔。
经机构审查委员会（IRB）批准，对所有结肠镜检查进行回顾，并前瞻性收集2010年1月1日至2014年3月31日期间由2名内镜医师在社区门诊内镜中心进行的抓持和圈套EMR的相关数据。该研究包括两个阶段。在第一阶段，使用抓持和圈套技术切除所有大小大于或等于1.2 cm的右侧扁平息肉。是否进行夹闭由内镜医师自行决定。在第二阶段，使用可吸收夹关闭所有黏膜缺损。如果穿孔发生率小于或等于2%，该研究的第二阶段有足够的样本量来检测穿孔率的统计学显著差异，共进行148例EMR。
在研究的第一阶段，共进行了2121例结肠镜检查。75例患者的95个大型息肉被切除。95例息肉切除术中发生4例穿孔（4.2%）。穿孔发生在大小为1.5 cm至2.5 cm的息肉中。在第二阶段，共进行了2464例结肠镜检查。116例患者的151个大型息肉被切除，所有黏膜缺损均进行了夹闭。无穿孔发生（P = 0.0016）。两个阶段均未发生息肉切除术后出血。平均需要2.15个夹子来关闭黏膜缺损。息肉切除和夹闭的中位时间为13分钟，中位手术时间为40分钟。在我们基于社区的门诊内镜中心，接受结肠镜检查的所有患者中有5%患有大小大于或等于1.2 cm的右侧扁平息肉。
对大型、右侧、扁平息肉的黏膜切除缺损进行预防性夹闭可降低穿孔发生率。
