Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan.
Department of Gastroenterology, JCHO Kyoto Kuramaguchi Medical Center, Kyoto, Japan.
Endoscopy. 2019 Sep;51(9):871-876. doi: 10.1055/a-0956-6879. Epub 2019 Jul 15.
We analyzed the efficacy of precutting endoscopic mucosal resection (EMR), which is a method of making a full or partial circumferential mucosal incision around a tumor with a snare tip for en bloc resection.
We reviewed cases from 2011 to 2018 in which precutting EMR (n = 167) and standard EMR (n = 557) were performed for lesions of 10 - 30 mm. Precutting EMR was indicated for benign lesions of 20 - 30 mm or lesions of < 20 mm for which standard EMR was difficult. Through propensity score matching of the two groups, the therapeutic outcomes for 35 lesions of ≥ 20 mm and 98 lesions of < 20 mm in each group were analyzed.
In the two sizes of lesion, there were significant differences between the precutting and standard groups in the en bloc resection rate (≥ 20 mm 88.6 % vs. 48.5 %, < 0.001; < 20 mm 98.0 % vs. 85.7 %, = 0.004) and the histological complete resection rate (≥ 20 mm 71.4 % vs. 42.9 %, = 0.02; < 20 mm 87.8 % vs. 67.3 %, < 0.001).
Precutting EMR enabled high en bloc resection rates in cases involving difficult lesions.
我们分析了内镜黏膜切除术（EMR）预切开的疗效，该方法是用圈套器尖端在肿瘤周围做一个全周或部分周的黏膜切口，整块切除。
我们回顾了 2011 年至 2018 年间进行的 167 例预切开 EMR 和 557 例标准 EMR 的病例，病变大小为 10-30mm。预切开 EMR 适用于 20-30mm 的良性病变或标准 EMR 困难的<20mm 病变。通过对两组进行倾向评分匹配，分析每组 35 个≥20mm 和 98 个<20mm 病变的治疗结果。
在两种大小的病变中，预切开组和标准组在整块切除率（≥20mm 88.6%比 48.5%，<0.001；<20mm 98.0%比 85.7%，=0.004）和组织学完全切除率（≥20mm 71.4%比 42.9%，=0.02；<20mm 87.8%比 67.3%，<0.001）方面均有显著差异。
预切开 EMR 可使困难病变的整块切除率提高。
