Chen Zongyu John, Batts Kenneth P
Minnesota Gastroenterology, Minneapolis, MN, United States.
Hospital Pathology Associates, Minneapolis, MN, United States.
Front Med (Lausanne). 2018 Nov 8;5:312. doi: 10.3389/fmed.2018.00312. eCollection 2018.
Postpolypectomy bleeding and incomplete polyp removal are important complication and quality concerns of colonoscopy for colon cancer prevention. We investigated if endoscopic mucosal stripping (EMS) as a technical modification of traditional cold snare polypectomy to avoid submucosal injury during removal of non-pedunculated colon polyps could prevent postpolypectomy bleeding and facilitate complete polyp removal. This is an Internal Review Board exemption-granted retrospective analysis of 5,142 colonoscopies with snare polypectomy performed by one of the authors (ZJC) at Minnesota Gastroenterology ambulatory endoscopy centers during a 12-year period divided into pre-EMS era (2005-2012, = 2,973) and EMS era (2013-2016, = 2169) with systemic adoption of EMS starting 2013. Change in postpolypectomy bleeding rate before and after EMS adoption and EMS polypectomy completeness were evaluated. Zero postpolypectomy bleeding case was found during EMS era (rate 0%) compared with 10 bleeding cases during pre-EMS era (rate 0.336%). This difference was statistically significant ( = 0.0055) and remained so after excluding 2 bleeding cases of pedunculated polyps ( = 0.012). All bleeding cases involved hot snare polypectomy. Histological examination of the involved polyps showed substantial submucosal vascular damage in contrast to a remarkable paucity of submucosa in comparable advanced polyps removed using EMS. Both biopsy and follow-up colonoscopy examination of the polypectomy sites confirmed that EMS more completely removed non-pedunculated advanced polyps. EMS polypectomy was effective in preventing postpolypectomy bleeding and facilitated complete polyp removal.
息肉切除术后出血和息肉切除不完全是结肠镜检查在预防结肠癌方面的重要并发症及质量问题。我们研究了作为传统冷圈套息肉切除术技术改进的内镜黏膜剥离术（EMS），在切除无蒂结肠息肉时避免黏膜下损伤，是否能预防息肉切除术后出血并促进息肉完全切除。这是一项经内部审查委员会批准的回顾性分析，对一位作者（ZJC）在明尼苏达胃肠病学门诊内镜中心进行的5142例采用圈套息肉切除术的结肠镜检查进行研究，研究时间为12年，分为EMS时代前（2005 - 2012年，n = 2973）和EMS时代（2013 - 2016年，n = 2169），自2013年起系统采用EMS。评估了采用EMS前后息肉切除术后出血率的变化以及EMS息肉切除的完整性。在EMS时代未发现息肉切除术后出血病例（发生率0%），而在EMS时代前有10例出血病例（发生率0.336%）。这种差异具有统计学意义（P = 0.0055），在排除2例有蒂息肉出血病例后仍具有统计学意义（P = 0.012）。所有出血病例均涉及热圈套息肉切除术。对相关息肉的组织学检查显示，与使用EMS切除的类似晚期息肉中显著缺乏黏膜下层形成对比，受累息肉存在大量黏膜下血管损伤。对息肉切除部位的活检及后续结肠镜检查均证实，EMS能更完全地切除无蒂晚期息肉。EMS息肉切除术在预防息肉切除术后出血及促进息肉完全切除方面有效。
