Division of Gastroenterology and Hepatology, Department of Internal Medicine, St Marianna University School of Medicine, Sugao Street 2-16-1, Miyamae-ku, Kawasaki-shi, Kanagawa, 216-8511, Japan.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, St Marianna University School of Medicine, Yokohama City Seibu Hospital, Yashi-cho 1197-1, Asahi-ku, Yokohama-shi, Kanagawa, 241-0811, Japan.
Surg Endosc. 2021 Apr;35(4):1820-1826. doi: 10.1007/s00464-020-07581-w. Epub 2020 Apr 30.
Tip-in endoscopic mucosal resection (EMR) is a modified EMR technique using which en bloc resection of large colorectal sessile polyps can be performed; however, its usefulness for colorectal sessile polyps of > 20 mm has not been reported. This study examined treatment outcomes of tip-in and conventional EMR for large colorectal sessile polyps of ≥ 20 mm.
This was a retrospective case-control study conducted at a single tertiary center in Japan. Subjects included those with large colorectal sessile polyps of ≥ 20 mm, excluding pedunculated-type polyps, who underwent endoscopic resection between January 2010 and January 2019. The primary outcome was endoscopic treatment outcomes when using tip-in and conventional EMR, and the secondary outcome was the local recurrence rate after endoscopic treatment.
Forty-three colorectal lesions were treated using tip-in EMR and 83 using conventional EMR. Tip-in EMR had a significantly higher en bloc resection rate (90.7% vs. 69.8.%), and significantly shorter treatment duration (6.64 ± 0.64 min vs. 10.47 ± 0.81 min) than conventional EMR. However, for lesions > 30 mm, en bloc resection rate was 50.0% and 52.6% for tip-in and conventional EMR, respectively, indicating no significant difference. Perforation rates with tip-in and conventional EMR were 4.6% and 3.6%, respectively, indicating no significant difference. Local recurrence was examined in 80 cases who were followed up for > 6 months after endoscopic resection; recurrence rate was 0% and 7.0% in tip-in and conventional EMR cases, respectively, without significance difference.
Tip-in EMR showed high en-block resection rate, particularly in polyps of < 30 mm, and no residual tumor was found. This technique is a potential endoscopic treatment alternative for large colorectal sessile polyps of ≥ 20 mm.
经皮内镜下黏膜切除术（EMR）是一种改良的 EMR 技术，可用于整块切除较大的结直肠无蒂息肉；然而，其对于 >20mm 的结直肠无蒂息肉的应用价值尚未见报道。本研究旨在探讨经皮内镜下黏膜切除术（tip-in EMR）和传统 EMR 治疗 >20mm 结直肠无蒂息肉的疗效。
本研究为单中心回顾性病例对照研究，在日本一家三级医院进行。纳入标准为 2010 年 1 月至 2019 年 1 月接受内镜下切除的 >20mm 的结直肠无蒂息肉患者，除外有蒂息肉。主要结局为 tip-in EMR 和传统 EMR 的内镜治疗效果，次要结局为内镜治疗后的局部复发率。
43 例结直肠病变采用 tip-in EMR 治疗，83 例采用传统 EMR 治疗。tip-in EMR 的整块切除率（90.7%比 69.8%）显著高于传统 EMR，治疗时间（6.64±0.64min 比 10.47±0.81min）显著短于传统 EMR。然而，对于 >30mm 的病变，tip-in EMR 的整块切除率为 50.0%，传统 EMR 为 52.6%，无显著差异。tip-in EMR 和传统 EMR 的穿孔率分别为 4.6%和 3.6%，无显著差异。80 例患者内镜切除后随访 >6 个月，检查局部复发情况；tip-in EMR 和传统 EMR 的复发率分别为 0%和 7.0%，无显著差异。
tip-in EMR 整块切除率高，尤其是对于 <30mm 的息肉，且未发现残留肿瘤。对于 >20mm 的结直肠无蒂息肉，该技术是一种有潜力的内镜治疗选择。
