Song Ji Hyun, Friedland Shai
Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea.
Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
Clin Endosc. 2021 May;54(3):397-403. doi: 10.5946/ce.2020.226. Epub 2021 Feb 9.
BACKGROUND/AIMS: Cold snare polypectomy (CSP) is an effective method of polyp removal for small colorectal polyps. However, the effect of submucosal injection in cold snare endoscopic mucosal resection (CS-EMR) for small polyps is unclear. Therefore, this study aimed to evaluate the effect of submucosal injection in CS-EMR for small polyps.
Between 2018 and 2019, 100 consecutive small colorectal polyps (5-10 mm) were identified in 58 patients. The first 50 consecutive polyps were removed by CS-EMR, and the remaining 50 were removed by CSP. Demographic data, clinical data, endoscopic findings, procedure times, complication rates, and pathology data were collected.
No difference in the complete resection rate was observed between the CS-EMR and CSP groups. A total of 9 polyps showed post-polypectomy bleeding (7 had immediate bleeding, 1 had delayed bleeding, and 1 had both immediate and delayed bleeding). No difference in the bleeding rate was observed between the two groups. In multivariate analysis, warfarin (odds ratio [OR], 42.334; 95% confidence interval [CI], 1.006-1,781.758) and direct-acting oral anticoagulants (OR, 35.244; 95% CI, 3.853-322.397) showed a significantly increased risk of bleeding.
The effect of submucosal injection in CSP was not significant for small colorectal polyps.
背景/目的：冷圈套息肉切除术（CSP）是切除小的结直肠息肉的有效方法。然而，在冷圈套内镜黏膜切除术（CS-EMR）中对小息肉进行黏膜下注射的效果尚不清楚。因此，本研究旨在评估在CS-EMR中对小息肉进行黏膜下注射的效果。
在2018年至2019年期间，在58例患者中识别出100个连续的小的结直肠息肉（5-10毫米）。前50个连续的息肉通过CS-EMR切除，其余50个通过CSP切除。收集人口统计学数据、临床数据、内镜检查结果、手术时间、并发症发生率和病理数据。
CS-EMR组和CSP组之间在完全切除率方面未观察到差异。共有9个息肉出现息肉切除术后出血（7个有即时出血，1个有延迟出血，1个既有即时出血又有延迟出血）。两组之间在出血率方面未观察到差异。在多变量分析中，华法林（比值比[OR]，42.334；95%置信区间[CI]，1.006-1,781.758）和直接作用口服抗凝剂（OR，35.244；95%CI，3.853-322.397）显示出血风险显著增加。
对于小的结直肠息肉，在CSP中进行黏膜下注射的效果不显著。
