Bar-Yishay Iddo, Shahidi Neal, Gupta Sunil, Vosko Sergei, van Hattem W Arnout, Schoeman Scott, Sidhu Mayenaaz, Tate David J, Hourigan Luke F, Singh Rajvinder, Moss Alan, Raftopoulos Spiro C, Brown Gregor, Zanati Simon, Heitman Steven J, Lee Eric Y T, Burgess Nicholas, Williams Stephen J, Byth Karen, Bourke Michael J
Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, Australia.
Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, Australia; Westmead Clinical School, University of Sydney, Sydney, Australia; University of British Columbia, Department of Medicine, Vancouver, Canada.
Clin Gastroenterol Hepatol. 2022 Feb;20(2):e139-e147. doi: 10.1016/j.cgh.2021.01.007. Epub 2021 Jan 8.
BACKGROUND & AIMS: Although perforation is the most feared adverse event associated with endoscopic mucosal resection (EMR), limited data exists concerning its management. Therefore, we sought to evaluate the short- and long-term outcomes of intra-procedural deep mural injury (DMI) in an international multi-center observational cohort of large (≥20 mm) non-pedunculated colorectal polyps (LNPCPs).
Consecutive patients who underwent EMR for a LNPCP ≥20 mm were evaluated. Significant DMI (S-DMI) was defined as Sydney DMI Classification type III (muscularis propria injury, target sign) or type IV/V (perforation without or with contamination, respectively). The primary outcome was successful S-DMI defect closure. Secondary outcomes included technical success (removal of all visible polypoid tissue during index EMR), surgical referral and recurrence at first surveillance colonscopy (SC1).
Between July 2008 to May 2020, 3717 LNPCPs underwent EMR. Median lesion size was 35mm (interquartile range (IQR) 25 to 45mm). Significant DMI was identified in 101 cases (2.7%), with successful defect closure in 98 (97.0%) using a median of 4 through-the-scope clips (TTSCs; IQR 3 to 6 TTSCs). Three (3.0%) patients underwent S-DMI-related urgent surgery. Technical success was achieved in 94 (93.1%) patients, with 46 (45.5%) admitted to hospital (median duration 1 day; IQR 1 to 2 days). Comparing LNPCPs with and without S-DMI, no differences in technical success (94 (93.1%) vs 3316 (91.7%); P = .62) or SC1 recurrence (12 (20.0%) vs 363 (13.6%); P = .15) were identified.
Significant DMI is readily managed endoscopically and does not appear to affect technical success or recurrence.
尽管穿孔是与内镜黏膜切除术（EMR）相关的最令人担忧的不良事件，但关于其处理的数据有限。因此，我们试图在一个国际多中心观察性队列中评估大型（≥20mm）无蒂结直肠息肉（LNPCP）的术中深层壁层损伤（DMI）的短期和长期结局。
对连续接受EMR治疗≥20mm的LNPCP患者进行评估。严重DMI（S-DMI）定义为悉尼DMI分类III型（固有肌层损伤，靶征）或IV/V型（分别为无污染或有污染的穿孔）。主要结局是S-DMI缺损成功闭合。次要结局包括技术成功（在初次EMR期间切除所有可见的息肉样组织）、手术转诊和首次结肠镜检查（SC1）时的复发。
2008年7月至2020年5月期间，3717例LNPCP接受了EMR。病变大小中位数为35mm（四分位间距（IQR）25至45mm）。101例（2.7%）发现有严重DMI，其中98例（97.0%）使用中位数为4个的经内镜金属夹（TTSC；IQR 3至6个TTSC）成功闭合缺损。3例（3.0%）患者接受了与S-DMI相关的急诊手术。94例（93.1%）患者技术成功，46例（45.5%）入院（住院时间中位数1天；IQR 1至2天）。比较有和没有S-DMI的LNPCP，在技术成功（94例（93.1%）对3316例（91.7%）；P = 0.62）或SC1复发（12例（20.0%）对363例（13.6%）；P = 0.15）方面未发现差异。
严重DMI很容易通过内镜处理，并且似乎不影响技术成功或复发。
