Rahmi Gabriel, Vinet Marie-Amélie, Perrod Guillaume, Saurin Jean-Christophe, Samaha Elia, Ponchon Thierry, Canard Jean-Marc, Edery Joël, Maoulida Hassani, Chatellier Gilles, Durand-Zaleski Isabelle, Cellier Christophe
Georges Pompidou European Hospital, Department of Gastroenterology and Endoscopy, 20 Rue Leblanc, 75015 Paris, France.
AP-HP URC-Eco Ile-de-France, Inserm U1123, University Paris Diderot, Sorbonne Paris Cité, Paris, France.
Therap Adv Gastroenterol. 2017 Jun;10(6):465-472. doi: 10.1177/1756283X17696232. Epub 2017 Mar 26.
We evaluated first the feasibility of endoscopic small-bowel polypectomy and second, the economic aspects, by comparing the cost of endoscopic and surgical polyp resection.
A prospective, observational, multicenter study included 494 patients with positive capsule endoscopy (CE) before double-balloon enteroscopy (DBE). We selected only CE with at least one polyp. The retrospective economic evaluation compared patients treated by DBE or surgery for small-bowel polypectomy. Hospital readmission because of repeat polyp resection or complication-related interventions was noted. The 1-year cost was estimated from the viewpoint of the healthcare system and included procedures, hospital admissions and follow up.
CE indicated one or more polyps in 62 (12.5%) patients (32 males, 49 ± 5 years), all of whom underwent a successful DBE exploration. The DBE polyp diagnostic yield was 58%. There were no major complications. A total of 26 (42%) patients in the DBE group and 19 (39%) in the control group required hospital readmission. All readmissions in the DBE group were for repeat procedures to remove all polyps, and in the control group, for surgical complications. The total cost of the initial hospitalization (€4014 ± 2239 DBE €11,620 ± 7183 surgery, < 0.0001) and the 1-year total cost (€8438 ± 9227 DBE €13,402 ± 7919 surgery, < 0.0001) were lower in the DBE group.
Endoscopic polypectomy was efficient and safe. The total cost at 1 year was less for endoscopy than surgery. DBE should be proposed as the first-line treatment for small-bowel polyp resection.
我们首先评估了内镜下小肠息肉切除术的可行性，其次通过比较内镜和手术切除息肉的成本，评估了其经济方面。
一项前瞻性、观察性、多中心研究纳入了494例在双气囊小肠镜检查（DBE）前胶囊内镜检查（CE）呈阳性的患者。我们仅选择至少有一个息肉的CE检查。回顾性经济评估比较了接受DBE或手术进行小肠息肉切除的患者。记录因重复息肉切除或并发症相关干预导致的医院再入院情况。从医疗保健系统的角度估计了1年的成本，包括手术、住院和随访。
CE显示62例（12.5%）患者有一个或多个息肉（32例男性患者，年龄49±5岁），所有这些患者均成功接受了DBE探查。DBE息肉诊断率为58%。无重大并发症。DBE组共有26例（42%）患者和对照组19例（39%）患者需要再次住院。DBE组的所有再入院均是为了重复手术以切除所有息肉，而对照组则是因为手术并发症。DBE组初始住院的总成本（4014±2239欧元，DBE组；11620±7183欧元，手术组，P<0.0001）和1年总成本（8438±9227欧元，DBE组；13402±7919欧元，手术组，P<0.0001）均较低。
内镜下息肉切除术有效且安全。内镜检查1年的总成本低于手术。DBE应被推荐为小肠息肉切除的一线治疗方法。
