Sidhu Mayenaaz, Shahidi Neal, Gupta Sunil, Desomer Lobke, Vosko Sergei, Arnout van Hattem W, Hourigan Luke F, Lee Eric Y T, Moss Alan, Raftopoulos Spiro, Heitman Steven J, Williams Stephen J, Zanati Simon, Tate David J, Burgess Nicholas, Bourke Michael J
Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia; Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia.
Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia; Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia; Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Gastroenterology. 2021 Jul;161(1):163-170.e3. doi: 10.1053/j.gastro.2021.03.044. Epub 2021 Mar 31.
BACKGROUND & AIMS: Thermal ablation of the defect margin after endoscopic mucosal resection (EMR-T) for treating large (≥20 mm) nonpedunculated colorectal polyps (LNPCPs) has shown efficacy in a randomized trial, with a 4-fold reduction, in residual or recurrent adenoma (RRA) at first surveillance colonoscopy (SC1). The clinical effectiveness of this treatment, in the real world, remains unknown.
We sought to evaluate the effectiveness of EMR-T in an international multicenter prospective trial (NCT02957058). The primary endpoint was the frequency of RRA at SC1. Detailed demographic, procedural, and outcome data were recorded. Exclusion criteria were LNPCPs involving the ileo-caecal valve, the appendiceal orifice, and circumferential LNPCPs.
During 51 months (May 2016-August 2020) 1049 LNPCPs in 1049 patients (median size, 35 mm; interquartile range, 25-45 mm; right colon location, 53.5%) were enrolled. Uniform completeness of EMR-T was achieved in 989 LNPCPs (95.4%). In this study, 755/803 (94.0%) eligible LNPCPs underwent SC1 (median time to SC1, 6 months; interquartile range, 5-7 months). For LNPCPs that underwent complete EMR-T, the frequency of RRA at SC1 was 1.4% (10/707).
In clinical practice, EMR-T is a simple, inexpensive, and highly effective auxiliary technique that is likely to significantly reduce RRA at first surveillance. It should be universally used for the management of LNPCPs after EMR. https://clinicaltrials.gov; Clinical Trial Number, NCT02957058.
在一项随机试验中，内镜黏膜切除术后进行缺损边缘热消融术（EMR-T）治疗大型（≥20 mm）无蒂结直肠息肉（LNPCP）已显示出疗效，首次结肠镜监测（SC1）时残留或复发性腺瘤（RRA）减少了4倍。在现实世界中，这种治疗方法的临床有效性尚不清楚。
我们试图在一项国际多中心前瞻性试验（NCT02957058）中评估EMR-T的有效性。主要终点是SC1时RRA的发生率。记录详细的人口统计学、手术和结局数据。排除标准为累及回盲瓣、阑尾开口的LNPCP以及环形LNPCP。
在51个月（2016年5月至2020年8月）期间，纳入了1049例患者的1049个LNPCP（中位大小为35 mm；四分位间距为25 - 45 mm；右半结肠位置占53.5%）。989个LNPCP（95.4%）实现了EMR-T的统一完整性。在本研究中，755/803（94.0%）符合条件的LNPCP接受了SC1（至SC1的中位时间为6个月；四分位间距为5 - 7个月）。对于接受完整EMR-T的LNPCP，SC1时RRA的发生率为1.4%（10/707）。
在临床实践中，EMR-T是一种简单、廉价且高效的辅助技术，可能会在首次监测时显著降低RRA。它应普遍用于EMR术后LNPCP的管理。https://clinicaltrials.gov；临床试验编号，NCT02957058。
