Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan.
Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan.
J Gastroenterol Hepatol. 2020 Feb;35(2):241-248. doi: 10.1111/jgh.14824. Epub 2019 Sep 10.
The true incidence of incomplete muscularis mucosa resection with cold snare polypectomy (CSP) is unknown. We examined the incidence of incomplete muscularis mucosa resection both with and without cold snare defect protrusion (CSDP).
We prospectively enrolled patients undergoing polypectomy for 4 to 9mm nonpedunculated polyps. We evaluated the presence of CSDP immediately following CSP and biopsied the CSDP or the center of the mucosal defect without CSDP. The presence of the muscularis mucosa and any residual polyp in the biopsies was evaluated histologically. The primary outcome was the incidence of incomplete mucosal layer resection defined as the presence of muscularis mucosa or residual polyp in the biopsies.
From August 2017 to October 2018, 188 patients were screened, and 357 polyps were included. CSDP was detected in 122/355 (34%) evaluated mucosal defects. Excluding five lesions requiring hemostasis immediately following CSP, 352 mucosal defects were biopsied. After excluding 102 biopsies containing normal mucosa, we evaluated 250 biopsies. The overall incidence of incomplete mucosal layer resection was 63% (159/250), 76% (68/90) with CSDP and 57% (91/159) without CSDP (P < 0.01). Both univariate and multivariate analyses showed that size (≥ 6 mm), resection time (≥ 5 s), and serrated lesions were risk factors for CSDP.
Cold snare defect protrusion (CSDP), which was present with 36%, was a good indicator for incomplete mucosal layer resection. Even in nonCSDP polypectomies, 57% of the mucosal layer was not removed completely. Thus, CSP should be used for intra-epithelial lesions only, and careful pretreatment evaluation is recommended.
冷圈套息肉切除术（CSP）中不完全黏膜下切除术的真实发生率尚不清楚。我们检查了有和无冷圈套缺陷突出（CSDP）时不完全黏膜下切除术的发生率。
我们前瞻性地招募了接受 4 至 9mm 无蒂息肉切除术的患者。我们在 CSP 后立即评估 CSDP 的存在，并对 CSDP 或无 CSDP 的黏膜缺损中心进行活检。活检标本中黏膜下层和任何残留息肉的存在情况通过组织学进行评估。主要结局是不完全黏膜层切除的发生率，定义为活检标本中存在黏膜下层或残留息肉。
从 2017 年 8 月至 2018 年 10 月，对 188 名患者进行了筛查，共纳入 357 个息肉。在评估的 122/355 个（34%）黏膜缺损中发现了 CSDP。排除 CSP 后立即需要止血的 5 个病变后，对 352 个黏膜缺损进行了活检。在排除 102 个包含正常黏膜的活检后，我们评估了 250 个活检标本。总的不完全黏膜层切除发生率为 63%（159/250），有 CSDP 者为 76%（68/90），无 CSDP 者为 57%（91/159）（P<0.01）。单因素和多因素分析均显示，大小（≥6mm）、切除时间（≥5s）和锯齿状病变是 CSDP 的危险因素。
冷圈套缺陷突出（CSDP）的发生率为 36%，是不完全黏膜下切除术的良好指标。即使在无 CSDP 的息肉切除术中，也有 57%的黏膜层未被完全切除。因此，CSP 只能用于上皮内病变，建议术前仔细评估。
