Van Overbeke L, Ilegems S, Mertens G, Mortier L, van Dongen J, Verbeke L, Van Dijck H, Jacomen G
Department of Gastroenterology/Hepatology. AZ St. Maarten, Mechelen.
Department of Pathology. AZ St. Maarten, Mechelen.
Acta Gastroenterol Belg. 2019 Oct-Dec;82(4):475-478.
Cold snare polypectomy (CSP) is an accepted technique to remove diminutive or small (6-9 mm) polyps. Here we present a series of CSP for advanced non-pedunculated polyps (> 10 mm).
This is a retrospective, single operator study. A total of 111 patients with non-pedunculated polyps (Paris classification 0-IIa, 0-IIb, 0-Is) estimated > 10 mm, underwent CSP.
A total of 129 polyps were removed (87 0-IIa, 18 0-IIb, 24 0-Is). The number of these polyps ranked according to size were as follows : 11-19 mm : 63 (49%), 20-29 mm : 44 (34%), > 30 mm : 22 (17%). Thirty-eight (29.5%) were sessile serrated adenomas, 47 (36%) were tubular adenomas, 25 (19.3%) were villous adenoma's and 18 (14%) were hyperplastic polyps. Forty-nine (38%) polyps were resected in a piecemeal fashion, submucosal injection with diluted Indigo Carmine was used in 24 (19%). Immediate oozing bleeding was frequent but in almost all patients rapid spontaneous haemostasis occurred. In only one patient haemostatic clipping was required (in order to achieve hemostasis). Preventive clipping was used in 3 patients. There were no complications. Seventy-two patients (with 87 lesions) had a follow-up colonoscopy. Of these 87 lesions, 9 had residual adenomatous tissue (10.3 %). According to the size of the original polyp, the distribution was as follows: 11-19 mm : 2/36 (5.5 %), 20-29 mm : 4/32 (12.5 %), > 30 mm : 3/19 (15.7%).
CSP for advanced, non-pedunculated lesions is feasible, effective and extremely safe.
冷圈套息肉切除术（CSP）是一种公认的切除微小或小（6 - 9毫米）息肉的技术。在此，我们展示了一系列针对高级别无蒂息肉（>10毫米）的CSP。
这是一项回顾性、单操作者研究。共有111例估计>10毫米的无蒂息肉（巴黎分类0-IIa、0-IIb,、0-Is）患者接受了CSP。
共切除129枚息肉（87枚0-IIa、18枚0-IIb、24枚0-Is）。这些息肉按大小排序的数量如下：11 - 19毫米：63枚（49%），20 - 29毫米：44枚（34%），>30毫米：22枚（17%）。38枚（29.5%）为无蒂锯齿状腺瘤，47枚（36%）为管状腺瘤，25枚（19.3%）为绒毛状腺瘤，18枚（14%）为增生性息肉。49枚（38%）息肉采用分块切除，24枚（19%）使用稀释靛胭脂进行黏膜下注射。即时渗血很常见，但几乎所有患者均迅速自行止血。仅1例患者需要止血夹闭（以实现止血）。3例患者采用预防性夹闭。无并发症发生。72例患者（87处病变）接受了结肠镜随访。在这87处病变中，9处有残留腺瘤组织（10.3%）。根据原息肉大小，分布如下：11 - 19毫米：2/36（5.5%），,20 - 29毫米：4/32（12.5%），>30毫米：3/19（15.7%）。
CSP用于高级别无蒂病变是可行、有效且极其安全的。
