Department of Gastroenterology, 900TH Hospital of Joint Logistics Support Force, Fuzhou, China.
Scand J Gastroenterol. 2020 Mar;55(3):362-370. doi: 10.1080/00365521.2020.1732456. Epub 2020 Mar 9.
Endoscopic resection of colorectal polyps is widely established as the optimal method to manage precancerous lesions. But the optimal technique for removal of the polyps is uncertain. The aim of this study was to compare the efficacy and safety of three methods for the management of 6-20mm colorectal polyps. A prospective, randomised controlled trial was conducted at the 900TH Hospital of Joint Logistics Support Force in Fujian, China. Endoscopically diagnosed colorectal polyps, 6-20 mm in size, were randomly assigned to the cold snare polypectomy (CSP), cold snare endoscopic mucosal resection (CS-EMR) or endoscopic mucosal resection (EMR) group. After polypectomy, additional 3-5 forceps biopsies by leading narrow-band imaging (NBI) were performed at the base and margins of polypectomy sites to assess the presence of residual polyp tissue and all samples were sent for histopathological analysis to assess completeness of resection. Polypectomy timing, tissue retrieval and complications were recorded at the time of the procedure. A total of 781 polyps in 404 patients were assessed and randomly assigned to each group. Of these, 763 polyps were finally analyzed based on the pathology results. The complete resection rates with CSP, CS-EMR and EMR were 81.6%, 94.1% and 95.5%, respectively ( < .001). The intraprocedural bleeding rate, immediately after polypectomy, was significantly higher in the CSP group than in the CS-EMR and EMR group (9.4% vs. 4.4% vs. 1.9%; < .001). However,delayed bleeding was higher in the EMR group than in the CSP and CS-EMR group (2.6% vs. 1.2% vs. 0.8%, respectively; = .215). In the multivariate analysis showed that the operation method, lesion size morphology and the number of resection were independent risk factors for complete resection rate (CRR) ( < .05), but the location and pathological classification of polyps had no significant influence on CRR. CS-EMR is safe and effective in the treatment of 6-20 mm colorectal polyps. Especially for 6-15 mm non-pedunculated polyps, CS-EMR has a high histological complete resection rate comparable to EMR, and retains the low risk of delayed complications after polypectomy with cold snare. CS-EMR is expected to become a more valuable new cold-cutting technique after cold snare polypectomy.
内镜下结直肠息肉切除术被广泛认为是治疗癌前病变的最佳方法。但息肉切除的最佳技术仍不确定。本研究旨在比较三种方法治疗 6-20mm 结直肠息肉的疗效和安全性。一项前瞻性、随机对照试验在中国福建联勤保障部队第 900 医院进行。内镜诊断为 6-20mm 大小的结直肠息肉被随机分配至冷圈套息肉切除术（CSP）、冷圈套内镜黏膜切除术（CS-EMR）或内镜黏膜切除术（EMR）组。息肉切除后，在息肉切除部位的基底和边缘处通过引导窄带成像（NBI）进行额外的 3-5 次咬检，以评估是否存在残留息肉组织，所有样本均用于组织病理学分析以评估切除的完整性。在手术过程中记录息肉切除时间、组织取出和并发症。共评估了 404 例患者的 781 个息肉，并随机分配至每组。其中，根据病理结果最终分析了 763 个息肉。CSP、CS-EMR 和 EMR 的完全切除率分别为 81.6%、94.1%和 95.5%（<0.001）。CSP 组术中即刻出血率明显高于 CS-EMR 和 EMR 组（9.4%比 4.4%比 1.9%；<0.001）。然而，EMR 组的迟发性出血率高于 CSP 和 CS-EMR 组（分别为 2.6%比 1.2%比 0.8%；=0.215）。多因素分析显示，手术方法、病变大小形态和切除次数是完全切除率（CRR）的独立危险因素（<0.05），但息肉的位置和病理分类对 CRR 无显著影响。CS-EMR 是一种安全有效的治疗 6-20mm 结直肠息肉的方法。特别是对于 6-15mm 无蒂息肉，CS-EMR 具有与 EMR 相当的高组织学完全切除率，并且保留了冷圈套息肉切除后迟发性并发症的低风险。CS-EMR 有望成为冷圈套息肉切除后的一种更有价值的新型冷切技术。
