Ohmori Masayasu, Yamasaki Yasushi, Iwagami Hiroyoshi, Nakahira Hiroko, Matsuura Noriko, Shichijo Satoki, Maekawa Akira, Kanesaka Takashi, Yamamoto Sachiko, Higashino Koji, Uedo Noriya, Ishihara Ryu, Okada Hiroyuki, Takeuchi Yoji
Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan.
Department of Gastroenterology, Okayama University Hospital, Okayama, Japan.
J Gastroenterol Hepatol. 2021 Sep;36(9):2568-2574. doi: 10.1111/jgh.15519. Epub 2021 May 5.
Local residual/recurrent colorectal lesions after endoscopic resection (ER) are difficult to treat with conventional ER. Underwater endoscopic mucosal resection (UEMR) and endoscopic submucosal dissection (ESD) are reportedly effective. We investigated the appropriate indications of ESD and UEMR for recurrent colorectal lesions.
This single-center, retrospective, observational study was conducted at a tertiary cancer institute. Patients who underwent UEMR or ESD for residual/recurrent colorectal lesions after ER from October 2013 to February 2019 were enrolled. Propensity score matching was performed between the UEMR and ESD groups to compare the clinical characteristics, treatment, and outcomes.
In total, 30 UEMRs and 21 ESDs were performed. Median (range) diameter of the lesions was 8 mm (2-22 mm) in UEMR and 15 mm (2-58 mm) in ESD. Median procedure time in UEMR was significantly shorter than that of ESD (4 min [2-15 min] vs 70 min [17-193 min], P < 0.001). En bloc and complete resection rates of ESD were significantly higher than that of UEMR (73% vs 100%, 41% vs 81%, respectively). No adverse events occurred with UEMR, but there were two cases (10%) of delayed perforation with ESD. Neither group reported recurrence after treatment. Propensity score-matched cases showed significantly shorter procedure time and hospitalization period in UEMR than in ESD.
The outcomes of UEMR and ESD were comparable. UEMR could be a useful salvage therapy for small local residual/recurrent colorectal lesions after ER with shorter procedure time and hospitalization period.
内镜切除（ER）术后局部残留/复发性结直肠病变难以采用传统ER治疗。据报道，水下内镜黏膜切除术（UEMR）和内镜黏膜下剥离术（ESD）有效。我们研究了ESD和UEMR治疗复发性结直肠病变的合适适应证。
本单中心、回顾性观察研究在一家三级癌症研究所进行。纳入2013年10月至2019年2月因ER术后残留/复发性结直肠病变接受UEMR或ESD治疗的患者。对UEMR组和ESD组进行倾向评分匹配，以比较临床特征、治疗及结局。
共进行了30例UEMR和21例ESD。UEMR组病变的中位（范围）直径为8 mm（2 - 22 mm），ESD组为15 mm（2 - 58 mm）。UEMR的中位手术时间显著短于ESD（4分钟[2 - 15分钟]对70分钟[17 - 193分钟]，P < 0.001）。ESD的整块切除率和完整切除率显著高于UEMR（分别为73%对100%，41%对81%）。UEMR未发生不良事件，但ESD有2例（10%）发生延迟穿孔。两组均未报告治疗后复发。倾向评分匹配病例显示，UEMR的手术时间和住院时间显著短于ESD。
UEMR和ESD的结局相当。UEMR对于ER术后局部小的残留/复发性结直肠病变可能是一种有用的挽救性治疗方法，手术时间和住院时间较短。
