Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, Korea.
Departments of Hospital Pathology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, Korea.
Surg Endosc. 2022 Mar;36(3):2087-2095. doi: 10.1007/s00464-021-08495-x. Epub 2021 Apr 28.
Sessile serrated lesions (SSLs) are more prone to incomplete resection than conventional adenomas. This study evaluated whether circumferential submucosal incision prior to endoscopic mucosal resection (CSI-EMR) can increase the rate of complete and en bloc resections of colorectal lesions with endoscopic features of SSL.
Retrospective analyses and propensity score matching were performed for the resection of colorectal lesions ≥ 10 mm with endoscopic features of SSL.
After 1:1 ratio matching, 127 lesions in the CSI-EMR group and 127 in the EMR group were selected for analysis. The median size of the lesions was 15 mm (IQR 12-16) in both groups. There was no significant difference in either the complete resection rate or en bloc resection rate between CSI-EMR and EMR groups (96.9% vs. 92.9%, P = 0.155; 92.1% vs. 89.0%, P = 0.391). By contrast, the R0 resection rate was significantly higher in the CSI-EMR group than in the EMR group (89.8% vs. 59.8%, P < 0.001). The median procedure time was significantly longer in the CSI-EMR group than in the EMR group (6.28 min vs. 2.55 min, P < 0.001), whereas there was no significant difference between the two groups in the incidence of adverse events or recurrence rate. Multivariate analysis showed that CSI-EMR was the only factor significantly associated with R0 resection (P < 0.001).
For colorectal lesions with endoscopic features of SSL, CSI-EMR does not increase the complete or en bloc resection rate, but does increase the R0 resection rate. The procedure time is longer for CSI-EMR than EMR. The association of CSI-EMR with R0 resection and non-recurrence should be further evaluated.
无蒂锯齿状病变（SSLs）比传统腺瘤更容易出现不完全切除。本研究评估了内镜黏膜切除（EMR）前环形黏膜下切开（CSI-EMR）是否可以提高内镜表现为 SSL 的结直肠病变的完全和整块切除率。
对内镜表现为 SSL 的 ≥ 10mm 结直肠病变进行回顾性分析和倾向评分匹配。
1：1 比例匹配后，CSI-EMR 组和 EMR 组分别有 127 个病变入选分析。两组病变的中位大小均为 15mm（IQR 12-16）。CSI-EMR 组和 EMR 组的完全切除率或整块切除率无显著差异（96.9% vs. 92.9%，P=0.155；92.1% vs. 89.0%，P=0.391）。相反，CSI-EMR 组的 R0 切除率显著高于 EMR 组（89.8% vs. 59.8%，P<0.001）。CSI-EMR 组的手术时间中位数显著长于 EMR 组（6.28 分钟 vs. 2.55 分钟，P<0.001），但两组不良事件发生率或复发率无显著差异。多变量分析显示，CSI-EMR 是唯一与 R0 切除显著相关的因素（P<0.001）。
对于内镜表现为 SSL 的结直肠病变，CSI-EMR 不会增加完全或整块切除率，但会增加 R0 切除率。CSI-EMR 的手术时间长于 EMR。CSI-EMR 与 R0 切除和无复发的相关性应进一步评估。
