Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, Okayama, Japan.
Department of Pathology, Kurashiki Central Hospital, Okayama, Japan.
Gastrointest Endosc. 2020 Sep;92(3):715-722.e1. doi: 10.1016/j.gie.2020.05.039. Epub 2020 May 31.
Cold snare polypectomy (CSP) of small colorectal polyps is widely used. However, the technique is still troubled by insufficient resection depth, which may prevent precise pathologic evaluation. In this study, we investigated whether submucosal injection of saline solution helps to achieve deeper resection in CSP.
The study was a single-center, prospective, randomized trial. Patients with small (3- to 10-mm diameter) nonpedunculated adenomatous or sessile serrated colorectal polyps were randomly allocated to either conventional CSP (C-CSP) or CSP with submucosal injection (CSP-SI). Primary outcome was the rate of complete muscularis mucosae (MM) resection, defined by the proportion of MM under the tumor more than 80% of the tumor's horizontal dimension. Secondary outcomes were the rates of negative lateral and vertical margins, fragmentation of resected specimens, conversion to hot snare mucosal resection, intraprocedural bleeding, delayed bleeding, and perforation.
Two hundred fourteen patients were randomly assigned to the CSP-SI (n = 107) or C-CSP (n = 107) group. The rate of complete MM resection was 43.9% in the CSP-SI group and 53.3% in the C-CSP group, a statistically insignificant difference. The rates of negative lateral margin and vertical margin (42.3% and 56.7%, respectively) in the CSP-SI group were significantly lower than those (58% and 76%) in the C-CSP group (P = .03 and P = .006, respectively). There was no polypectomy-related major bleeding or perforation.
Saline solution injection into the submucosa did not improve the resection depth of CSP of small colorectal polyps, and the method resulted in lower rates of negative lateral and vertical margins of resected lesions. (Clinical trial registration number: UMIN000037980.).
冷圈套息肉切除术（CSP）广泛应用于小的结直肠息肉切除。然而，该技术仍存在切除深度不足的问题，这可能会影响精准的病理评估。本研究旨在探讨黏膜下注射生理盐水是否有助于 CSP 实现更深的切除。
本研究为单中心、前瞻性、随机对照试验。纳入的患者为直径 3-10mm 的无蒂管状腺瘤或无蒂锯齿状息肉，随机分为 CSP 组（C-CSP）和黏膜下注射 CSP 组（CSP-SI）。主要终点为完全切除黏膜肌层（MM）的比例，定义为肿瘤下 MM 超过肿瘤水平直径 80%的比例。次要终点为阴性侧切缘和垂直切缘、标本碎裂、转为热圈套黏膜切除术、术中出血、迟发性出血和穿孔的发生率。
共 214 例患者随机分配至 CSP-SI 组（n=107）或 C-CSP 组（n=107）。CSP-SI 组完全切除 MM 的比例为 43.9%，C-CSP 组为 53.3%，两组差异无统计学意义。CSP-SI 组的侧切缘和垂直切缘阴性率（分别为 42.3%和 56.7%）明显低于 C-CSP 组（分别为 58%和 76%）（P=0.03 和 P=0.006）。两组均无息肉切除相关的大出血或穿孔。
黏膜下注射生理盐水并未改善 CSP 切除小的结直肠息肉的深度，该方法导致切除标本的侧切缘和垂直切缘阴性率更低。（临床试验注册号：UMIN000037980.）
