Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan.
Translational Research and Development Center, Chiba University Hospital, Chiba, Japan.
Dig Endosc. 2019 Nov;31(6):662-671. doi: 10.1111/den.13427. Epub 2019 May 27.
Cold snare polypectomy (CSP) is a safe treatment for colorectal adenomas. However, the R0 resection rate is not sufficiently high because of inadequate resection of muscularis mucosa. We hypothesized that CSP in an underwater environment could improve this procedure by helping to safely achieve resection containing the muscularis mucosa. We have named this procedure underwater cold snare polypectomy (UCSP). We aimed to investigate the efficacy and safety of UCSP for colorectal adenomas.
Between May 2017 and April 2018, patients diagnosed with colorectal adenomas <9 mm underwent UCSP. After follow-up colonoscopy 3 weeks later, the patients post-UCSP scars were biopsied. Outcomes were compared with those of a historical control group who underwent conventional CSP in our previous study using propensity score-matching methods.
Overall, 224 lesions in 65 patients were prospectively resected by UCSP. Pathologically, 209 lesions were adenomas (4.5 ± 1.5 mm) including one intramucosal carcinoma. Only one pathological residual adenoma was identified, but there was no significant difference in the residual rate between the UCSP and CSP groups (both 1.0%). No complications were observed. R0 resection rate and rate of area containing the muscularis mucosa in the UCSP group were significantly higher than those in the CSP group (80.2% vs 32.7%, P < 0.001; 50.0% vs 35.3%, P = 0.015).
Underwater cold snare polypectomy for diminutive and small colorectal adenomas was safe and effective from the perspective of pathological complete resection, which is likely facilitated by achieving an adequate depth of resection.
冷圈套息肉切除术（CSP）是一种安全的结直肠腺瘤治疗方法。然而，由于黏膜肌层切除不足，R0 切除率不够高。我们假设水下环境中的 CSP 可以通过帮助安全地实现包含黏膜肌层的切除来改善该过程。我们将此过程命名为水下冷圈套息肉切除术（UCSP）。我们旨在研究 UCSP 治疗结直肠腺瘤的疗效和安全性。
2017 年 5 月至 2018 年 4 月，对诊断为 <9mm 的结直肠腺瘤患者行 UCSP。3 周后行随访结肠镜检查，对 UCSP 后患者的疤痕进行活检。采用倾向评分匹配方法，将这些结果与我们之前研究中采用传统 CSP 的历史对照组进行比较。
共有 65 例患者的 224 处病变被前瞻性地采用 UCSP 切除。病理上，209 处病变为腺瘤（4.5±1.5mm），其中 1 处为黏膜内癌。仅发现 1 处病理残留腺瘤，但 UCSP 和 CSP 组的残留率无显著差异（均为 1.0%）。未观察到并发症。UCSP 组的 R0 切除率和包含黏膜肌层的区域率明显高于 CSP 组（80.2%比 32.7%，P<0.001；50.0%比 35.3%，P=0.015）。
从病理完全切除的角度来看，UCSP 治疗小尺寸结直肠腺瘤是安全有效的，这可能是由于实现了足够的切除深度。
