Emmanuel Andrew, Gulati Shraddha, Burt Margaret, Hayee Bu'Hussain, Haji Amyn
King's Institute of Therapeutic Endoscopy, King's College Hospital, London, UK.
Eur J Gastroenterol Hepatol. 2018 May;30(5):506-513. doi: 10.1097/MEG.0000000000001086.
Endoscopic resection of large colorectal polyps is well established. However, significant differences in technique exist between eastern and western interventional endoscopists. We report the results of endoscopic resection of large complex colorectal lesions from a specialist unit that combines eastern and western techniques for assessment and resection.
Endoscopic resections of colorectal lesions of at least 2 cm were included. Lesions were assessed using magnification chromoendoscopy supplemented by colonoscopic ultrasound in selected cases. A lesion-specific approach to resection with endoscopic mucosal resection or endoscopic submucosal dissection (ESD) was used. Surveillance endoscopy was performed at 3 (SC1) and 12 (SC2) months.
Four hundred and sixty-six large (≥20 mm) colorectal lesions (mean size 54.8 mm) were resected. Three hundread and fifty-six were resected using endoscopic mucosal resection and 110 by ESD or hybrid ESD. Fifty-one percent of lesions had been subjected to previous failed attempts at resection or heavy manipulation (≥6 biopsies). Nevertheless, endoscopic resection was deemed successful after an initial attempt in 98%. Recurrence occurred in 15% and could be treated with endoscopic resection in most. Only two patients required surgery for perforation. Nine patients had postprocedure bleeding; only two required endoscopic clips. Ninety-six percent of patients without invasive cancer were free from recurrence and had avoided surgery at last follow-up.
Combining eastern and western practices for assessment and resection results in safe and effective organ-conserving treatment of complex colorectal lesions. Accurate assessment before and after resection using magnification chromoendoscopy and a lesion-specific approach to resection, incorporating ESD where appropriate, are important factors in achieving these results.
大肠大息肉的内镜下切除术已得到广泛认可。然而，东西方介入内镜医师在技术上存在显著差异。我们报告了一个结合东西方技术进行评估和切除的专科单位对大肠复杂大病变进行内镜下切除的结果。
纳入至少2厘米的大肠病变的内镜下切除术。病变采用放大染色内镜评估，部分病例辅以结肠镜超声检查。采用针对病变的方法，使用内镜黏膜切除术或内镜黏膜下剥离术（ESD）进行切除。在3个月（SC1）和12个月（SC2）时进行监测性内镜检查。
共切除466个大（≥20毫米）的大肠病变（平均大小54.8毫米）。356个采用内镜黏膜切除术切除，110个采用ESD或混合ESD切除。51%的病变此前曾有切除失败或重度操作（≥6次活检）。然而，98%的病例首次尝试内镜下切除即获成功。15%出现复发，多数可通过内镜下切除治疗。仅2例患者因穿孔需要手术。9例患者术后出血；仅2例需要内镜夹闭。96%无浸润癌的患者无复发，在最后一次随访时避免了手术。
结合东西方评估和切除方法可安全有效地对复杂大肠病变进行保留器官的治疗。使用放大染色内镜在切除前后进行准确评估，以及采用针对病变的切除方法，在适当情况下采用ESD，是取得这些结果的重要因素。
