Hong Ji-Yun, Kweon Sun-Seog, Lee Jun, Kim Sang-Wook, Seo Geom-Seog, Kim Hyun-Soo, Joo Young-Eun
Department of Internal Medicine.
Department of Preventive Medicine, Chonnam National University Medical School.
Medicine (Baltimore). 2018 Oct;97(41):e12589. doi: 10.1097/MD.0000000000012589.
Colorectal laterally spreading tumors (LSTs) are large and flat elevated neoplasms with diameters of at least 10 mm. Endoscopic resection of LSTs, with their large size and broad base, is difficult and dangerous compared with the resection of polypoid neoplasms. This study aimed to determine the risk factors for procedure-related complications including bleeding and perforation after endoscopic resection of LSTs.Patients with colorectal LST undergoing endoscopic resection at 5 university hospitals in Honam Province of South Korea were enrolled, and their records about patients, lesions, and procedure parameters associated with the occurrence of complications were reviewed retrospectively. Logistic regression analysis was performed to identify risk factors for complications.The frequency of comorbidities in bleeding group was significantly higher than in the no bleeding group. The frequency of bleeding was significantly higher in lesions with adenocarcinoma than in lesions with low or high-grade dysplasia. The frequency of bleeding was significantly higher in piecemeal resection than in en bloc resection. The frequency of perforation was significantly higher in endoscopic mucosal resection-precutting (EMR-P) than in endoscopic mucosal resection (EMR) or endoscopic submucosal dissection. The mean procedure duration was significantly longer in the perforation group than in the no perforation group. On multivariate analysis, patient comorbidity and histologic grade of the lesion were significant independent risk factors for bleeding, whereas EMR-P was a significant independent risk factor for perforation after endoscopic resection.This study demonstrated that patient comorbidity and histologic grade of lesion were significant independent risk factors for bleeding, and EMR-P was a significant independent risk factor for perforation after endoscopic resection of colorectal LSTs.
结直肠侧向发育型肿瘤（LSTs）是直径至少为10毫米的大而扁平的隆起性肿瘤。与息肉样肿瘤切除相比，LSTs尺寸大且基底宽，其内镜下切除困难且危险。本研究旨在确定结直肠LSTs内镜切除术后包括出血和穿孔在内的手术相关并发症的危险因素。
纳入在韩国全罗南道5家大学医院接受内镜切除的结直肠LSTs患者，并回顾其关于患者、病变以及与并发症发生相关的手术参数的记录。进行逻辑回归分析以确定并发症的危险因素。
出血组的合并症发生率显著高于无出血组。腺癌病变的出血发生率显著高于低级别或高级别发育异常病变。分块切除的出血发生率显著高于整块切除。内镜黏膜下剥离术预切开（EMR-P）的穿孔发生率显著高于内镜黏膜切除术（EMR）或内镜黏膜下剥离术。穿孔组的平均手术时间显著长于无穿孔组。多因素分析显示，患者合并症和病变的组织学分级是出血的显著独立危险因素，而EMR-P是结直肠LSTs内镜切除术后穿孔的显著独立危险因素。
本研究表明，患者合并症和病变的组织学分级是出血的显著独立危险因素，而EMR-P是结直肠LSTs内镜切除术后穿孔的显著独立危险因素。
