Schett B, Wallner J, Weingart V, Ayvaz A, Richter U, Stahl J, Allescher H-D
Zentrum für Innere Medizin, Klinikum Garmisch-Partenkirchen, Auenstr. 6, 82467 Garmisch-Partenkirchen, Germany.
Institut für Pathologie, Klinikum Garmisch-Partenkirchen, Auenstr. 6, 82467 Garmisch-Partenkirchen, Germany.
Endosc Int Open. 2017 Jul;5(7):E580-E586. doi: 10.1055/s-0043-105491. Epub 2017 Jun 23.
Removal of polyps during colonoscopy effectively prevents the development of colorectal cancer. So far, snare resection with high frequency current with or without prior submucosal saline injection is the method of choice. The aim of this study was to evaluate the feasibility, safety, and outcome of cold snare resection during routine endoscopy.
In this prospective study, 522 patients undergoing outpatient colonoscopy were included. Cold snare resection for diminutive (< 6 mm), small (6 - 9 mm), and larger polyps (> 9 - 15 mm) was performed using a dedicated cold snare device (Exacto ) without prior submucosal injection. Outcome parameters included bleeding rate, perforation rate, procedure time, histologic evaluation of polyp margins, and success rates. The data were compared to a group of patients undergoing hot snare resection.
Overall, 1233 polyps were removed using cold snare resection with an overall success rate of 99.4 %. All failures of cold snare resection occurred in the cecum (8/82, failure rate 9.8 %). In the remaining colon, the success rate was 100 %. Immediate post-polypectomy bleeding occurred in 0.49 % of all patients and was most frequently seen in polyps larger than 9 mm. The procedure time was significantly shorter using cold snare resection compared with hot snare resection (27.6 min vs. 35.7 min, < 0.01).
Cold snare resection can be performed safely in outpatients for removal of small polyps in screening colonoscopy. It does not require prior saline injection and reduces procedure time without an increased risk of bleeding.
结肠镜检查时切除息肉可有效预防结直肠癌的发生。到目前为止，高频电圈套切除术（无论是否预先进行黏膜下注射生理盐水）是首选方法。本研究的目的是评估在常规内镜检查中进行冷圈套切除术的可行性、安全性及结果。
在这项前瞻性研究中，纳入了522例行门诊结肠镜检查的患者。使用专用冷圈套器（Exacto ）对微小（<6mm）、小（6 - 9mm）和较大息肉（>9 - 15mm）进行冷圈套切除术，无需预先进行黏膜下注射。结果参数包括出血率、穿孔率、操作时间、息肉边缘的组织学评估及成功率。将数据与一组接受热圈套切除术的患者进行比较。
总体而言，使用冷圈套切除术共切除1233枚息肉，总成功率为99.4%。冷圈套切除术的所有失败病例均发生在盲肠（8/82，失败率9.8%）。在其余结肠，成功率为100%。所有患者中息肉切除术后立即出血的发生率为0.49%，最常见于大于9mm的息肉。与热圈套切除术相比，冷圈套切除术的操作时间明显更短（27.6分钟对35.7分钟， <0.01）。
在门诊患者中，冷圈套切除术可安全用于筛查结肠镜检查中切除小息肉。它无需预先注射生理盐水，可缩短操作时间且不增加出血风险。
