Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan.
Gastrointest Endosc. 2019 Mar;89(3):470-478. doi: 10.1016/j.gie.2018.08.051. Epub 2018 Sep 8.
It is believed that preoperative biopsy sampling for superficial-type colorectal tumors should be avoided because submucosal fibrosis caused by biopsy sampling makes EMR impossible. However, few studies have reported the influence of biopsy sampling on colorectal endoscopic submucosal dissection (ESD). This study aimed to examine the effect of biopsy sampling on submucosal fibrosis and treatment outcomes of ESD for laterally spreading tumors (LSTs).
Between April 2005 and September 2015, 441 consecutive patients underwent colorectal ESD in Osaka City University Hospital. Using propensity score matching and inverse probability of treatment weighting (IPTW), we retrospectively evaluated risk factors for severe submucosal fibrosis and treatment outcomes for patients with LSTs, with or without preoperative biopsy sampling.
A total of 428 LSTs resected using ESD were enrolled. After matching, there were 136 matched pairs of lesions that did or did not undergo biopsy sampling. Preoperative biopsy sampling increased severe fibrosis compared with that in the non-biopsy sampling group (20.6% vs 11.0%; P = .03) and was significantly associated with severe fibrosis after matching (odds ratio [OR], 2.09; 95% confidence interval [CI], 1.07-4.10; P = .03). After adjustment with IPTW, biopsy sampling also increased the risk of severe fibrosis (OR, 2.33; 95% CI, 1.17-4.63; P = .02). However, no significant differences were observed between the 2 groups in treatment outcomes.
Preoperative biopsy sampling for colorectal LSTs might cause severe submucosal fibrosis but has no adverse influence on clinical outcomes of ESD.
人们认为应避免对浅表型结直肠肿瘤进行术前活检取样，因为活检取样导致的黏膜下纤维化会使内镜黏膜下剥离术（ESD）无法进行。然而，鲜有研究报道活检取样对结直肠内镜黏膜下挖除术（ESD）治疗侧向扩展型肿瘤（LST）的影响。本研究旨在研究活检取样对黏膜下纤维化的影响以及 LST 患者 ESD 治疗结果。
2005 年 4 月至 2015 年 9 月，大阪市立大学医院对 441 例连续患者进行了结直肠 ESD。通过倾向评分匹配和逆概率加权（IPTW），我们回顾性评估了 LST 患者接受或不接受术前活检取样的严重黏膜下纤维化风险因素和治疗结果。
共纳入 428 例使用 ESD 切除的 LST。匹配后，有 136 对病变存在或不存在活检取样。与非活检取样组相比，术前活检取样增加了严重纤维化的发生率（20.6%比 11.0%；P =.03），且在匹配后与严重纤维化显著相关（比值比 [OR]，2.09；95%置信区间 [CI]，1.07-4.10；P =.03）。经 IPTW 调整后，活检取样也增加了严重纤维化的风险（OR，2.33；95% CI，1.17-4.63；P =.02）。然而，两组在治疗结果方面无显著差异。
结直肠 LST 术前活检取样可能导致严重的黏膜下纤维化，但对 ESD 的临床结果无不良影响。
