Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia.
Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Mater Health, Brisbane, Queensland, Australia.
Gastrointest Endosc. 2018 Mar;87(3):837-842. doi: 10.1016/j.gie.2017.11.002. Epub 2017 Nov 10.
The optimal technique for the resection of sessile serrated polyps (SSPs) is unknown, with established limitations and risks with conventional polypectomy. Although cold snare polypectomy is safe, the efficacy of piecemeal resection for large lesions is untested. In this study we evaluate the safety and efficacy of cold EMR for large SSPs.
Patients presenting for elective colonoscopy at an academic endoscopy center with 1 or more SSPs ≥10 mm in size were enrolled, excluding those on anticoagulant or antiplatelet therapy other than aspirin. Lesions were resected with a cold EMR technique comprising submucosal injection of succinylated gelatin and dilute methylene blue before piecemeal cold snare resection of all visible polyp with a margin of normal tissue. Outcomes were the presence of residual serrated neoplasia in biopsy specimens from the defect margin and findings on surveillance colonoscopy.
Cold EMR was performed on 163 SSPs during 105 procedures in 99 patients (97% women; median age, 57 years). The mean size was 17.5 mm: 61 SSPs were ≥20 mm and 13 SSPs ≥30 mm, and 97.5% were in the proximal colon. Cytologic dysplasia was present in 2 (1.2%). Margin biopsy specimens were positive in 2 lesions (1.2%). Surveillance colonoscopy for 82% of lesions (median, 5 months) showed residual serrated tissue in 1, treated with cold snare, but no evidence of recurrence in the remainder. Minor adverse events were seen in 3 patients; no delayed bleeding was observed.
Cold EMR is a safe and effective method for the removal of large SSPs.
目前对于广基锯齿状息肉（SSP）的最佳切除方法仍不明确，传统息肉切除术存在一定局限性和风险。虽然冷圈套息肉切除术是安全的，但大块病变的分片切除效果尚未得到验证。本研究旨在评估冷内镜黏膜切除术（EMR）治疗大型 SSP 的安全性和有效性。
本研究纳入在学术内镜中心行择期结肠镜检查、存在 1 个或多个≥10mm 的 SSP 且除外正在接受抗凝或抗血小板治疗（除阿司匹林外）的患者。采用冷 EMR 技术切除病变，包括黏膜下注射琥珀酰明胶和稀亚甲蓝，然后分片切除所有可见息肉，并用正常组织边缘冷圈套切除。主要转归为活检标本边缘存在锯齿状肿瘤残留和结肠镜随访结果。
99 例患者共 105 次操作中对 163 个 SSP 行冷 EMR（97.5%为女性，中位年龄 57 岁）。平均息肉大小为 17.5mm：61 个≥20mm，13 个≥30mm，97.5%位于近端结肠。2 个（1.2%）病变存在细胞学异型增生，2 个（1.2%）边缘活检标本阳性。82%（中位随访 5 个月）的病变行结肠镜随访，其中 1 个可见锯齿状组织残留，采用冷圈套切除，其余未见复发。3 例患者出现轻微不良事件，无迟发性出血。
冷 EMR 是一种安全有效的治疗大型 SSP 的方法。
