Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Boulevard, South Pavilion, 4th Floor, Philadelphia, PA, 19104, USA.
Surg Endosc. 2018 Apr;32(4):1871-1878. doi: 10.1007/s00464-017-5876-3. Epub 2017 Sep 22.
Sessile serrated polyps (SSPs) are associated with higher rates of incomplete resection compared to conventional adenomas after traditional snare polypectomy. Outcomes after endoscopic mucosal resection (EMR) are less established. The aim of this study was to evaluate the rate of residual neoplasia at surveillance colonoscopy for SSPs compared to conventional adenomas ≥ 10 mm after en bloc EMR.
Retrospective cohort study of consecutive patients referred for EMR of a colonic lesion ≥ 10 mm from 2005 to 2013. Data on procedures, histopathology, and surveillance colonoscopies were recorded. The primary outcome was rate of macroscopically evident residual neoplasia at surveillance colonoscopy for SSPs compared to adenomas. Secondary outcomes included rate of neoplasia at the resection margin.
283 consecutive patients with 293 polyps underwent en bloc EMR including 101 SSPs and 192 adenomas. Pathology commented on the lateral resection margins of the specimen in 235 cases (80%). Of these, neoplasia was noted at the resection margin in 29/64 SSPs (45.3%) compared to 65/171 adenomas (38.0%; P = .37). Surveillance data were available for 153 index lesions with a median interval of 13 months (interquartile range, 10.75-23.25 months). Ten resection sites (6.5%) were found to have residual neoplasia, including 2/52 SSPs (3.8%) and 8/101 adenomas (7.9%; P = .50). Of the cases with surveillance data 128/153 (84%) commented on the lateral margin of the resection specimen. Residual neoplasia was noted in 3/68 lesions (4.4%) with negative margins compared to 5/60 lesions (8.3%) with positive margins (P = .47).
En bloc EMR for colonic lesions ≥ 10 mm is associated with a 6.5% rate of macroscopic residual neoplasia. Although 45% of SSPs had neoplasia extending to the resection margin, rates of residual neoplasia at surveillance colonoscopy were low. These results suggest that when feasible en bloc EMR is a reasonable option to resect SSPs ≥ 10 mm.
与传统圈套息肉切除术相比，无蒂锯齿状息肉（SSP）在传统圈套息肉切除术后的不完全切除率更高。内镜黏膜切除术（EMR）的结果尚不明确。本研究旨在评估与 10mm 以上传统腺瘤相比，整块 EMR 后 SSPS 在监测结肠镜检查中残留肿瘤的发生率。
对 2005 年至 2013 年间连续接受 EMR 治疗的结肠病变≥10mm 的患者进行回顾性队列研究。记录了手术过程、组织病理学和监测结肠镜检查的数据。主要结局是与腺瘤相比，SSP 在监测结肠镜检查中残留肿瘤的宏观表现率。次要结局包括切除边缘的肿瘤发生率。
283 例连续患者共 293 个息肉接受了整块 EMR，包括 101 个 SSP 和 192 个腺瘤。235 例标本的侧向切除边缘有病理学评价（80%）。其中，64 个 SSP 中有 29 个（45.3%）和 171 个腺瘤中有 65 个（38.0%）有肿瘤累及切缘（P=0.37）。153 个指数病变中有 13 个月的中位间隔（四分位距，10.75-23.25 个月）可获得监测数据。10 个切除部位（6.5%）发现有残留肿瘤，包括 52 个 SSP 中有 2 个（3.8%）和 101 个腺瘤中有 8 个（7.9%）（P=0.50）。在有监测数据的病例中，153 例中的 128 例（84%）对切除标本的侧向边缘进行了评价。与阴性边缘的 68 个病变中的 3 个（4.4%）相比，阳性边缘的 60 个病变中有 5 个（8.3%）（P=0.47）有残留肿瘤。
对于结肠病变≥10mm 的整块 EMR 与 6.5%的肉眼残留肿瘤发生率相关。尽管 45%的 SSP 有肿瘤累及切缘，但监测结肠镜检查中残留肿瘤的发生率较低。这些结果表明，在可行的情况下，整块 EMR 是切除≥10mm SSP 的合理选择。
