Song Eun Mi, Yang Hyo-Joon, Lee Hyun Jung, Lee Hyun Seok, Cha Jae Myung, Kim Hyun Gun, Jung Yunho, Moon Chang Mo, Kim Byung Chang, Byeon Jeong-Sik
Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
Dig Dis Sci. 2017 Nov;62(11):3138-3148. doi: 10.1007/s10620-017-4760-2. Epub 2017 Sep 21.
Endoscopic resection of polyps located at the appendiceal orifice (AO) is challenging, and the feasibility and outcomes of endoscopic resection for cecal polyps involving AO are unconfirmed.
We evaluated the feasibility and outcomes of endoscopic resection for cecal polyps involving AO.
In this retrospective, multicenter study involving nine tertiary referral centers, we evaluated 131 patients who underwent endoscopic resection for cecal polyps involving AO.
The median size of polyps resected was 10 mm (range 3-60 mm). Endoscopic mucosal resection, endoscopic piecemeal mucosal resection, and endoscopic submucosal dissection were performed in 75 (57.3%), 31 (23.7%), and 5 (3.8%) patients, respectively. The en bloc resection rate was 68.7%. Endoscopic complete resection was achieved in 123 lesions (93.9%). Intraprocedural and delayed bleeding occurred in 14 (10.7%) and three patients (2.3%), respectively, and perforation occurred in two patients (1.5%). Seven patients (5.3%) underwent additional surgery because of treatment failure or recurrence. Polyps of ≥20 mm in size showed significantly higher rates of perforation and additional surgery (p < 0.05), and a lower rate of en bloc resection (p < 0.005). Patients with polyps involving ≥75% of AO circumference exhibited a significantly lower rate of en bloc resection (p < 0.001), and significantly higher rates of surgery and recurrence (p < 0.05). Recurrence during follow-up occurred in 12 patients (15.6%); polyps involving ≥75% of AO circumference were an independent risk factor for recurrence.
Endoscopic resection of cecal polyps involving AO is safe and effective in select patients.
对位于阑尾开口处（AO）的息肉进行内镜切除具有挑战性，且涉及AO的盲肠息肉内镜切除的可行性和结果尚未得到证实。
我们评估了涉及AO的盲肠息肉内镜切除的可行性和结果。
在这项涉及9个三级转诊中心的回顾性多中心研究中，我们评估了131例接受了涉及AO的盲肠息肉内镜切除的患者。
切除息肉的中位大小为10毫米（范围3 - 60毫米）。分别有75例（57.3%）、31例（23.7%）和5例（3.8%）患者接受了内镜黏膜切除术、内镜分片黏膜切除术和内镜黏膜下剥离术。整块切除率为68.7%。123个病变（93.9%）实现了内镜下完整切除。术中出血和迟发性出血分别发生在14例（10.7%）和3例（2.3%）患者中，穿孔发生在2例（1.5%）患者中。7例（5.3%）患者因治疗失败或复发接受了额外手术。大小≥20毫米的息肉穿孔率和额外手术率显著更高（p < 0.０5），整块切除率更低（p < 0.005）。息肉累及AO周长≥75%的患者整块切除率显著更低（p < 0.001），手术率和复发率显著更高（p < 0.05）。随访期间12例（15.6%）患者复发；息肉累及AO周长≥75%是复发的独立危险因素。
对于部分患者，内镜切除涉及AO的盲肠息肉是安全有效的。
