Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia.
Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia; Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia.
Gastrointest Endosc. 2021 Nov;94(5):959-968.e2. doi: 10.1016/j.gie.2021.05.011. Epub 2021 May 11.
The endoscopic management of large nonpedunculated colorectal polyps involving the ileocecal valve (ICV-LNPCPs) remains challenging because of its unique anatomic features, with long-term outcomes inferior to LNPCPs not involving the ICV. We sought to evaluate the impact of technical innovations and advances in the EMR of ICV-LNPCPs.
The performance of EMR for ICV-LNPCPs was retrospectively evaluated in a prospective observational cohort of LNPCPs ≥20 mm. Efficacy was measured by clinical success (removal of all polypoid tissue during index EMR and avoidance of surgery) and recurrence at first surveillance colonoscopy. Accounting for the adoption of technical innovations, comparisons were made between an historical cohort (September 2008 to April 2016) and contemporary cohort (May 2016 to October 2020). Safety was evaluated by documenting the frequencies of intraprocedural bleeding, delayed bleeding, deep mural injury, and delayed perforation.
Between September 2008 to October 2020, 142 ICV-LNPCPs were referred for EMR. Median ICV-LNPCP size was 35 mm (interquartile range, 25-50 mm). When comparing the contemporary (n = 66) and historical cohorts (n = 76) of ICV-LNPCPs, there were significant differences in clinical success (93.9% vs 77.6%, P = .006) and recurrence (4.6% vs 21.0%, P = .019).
With technical advances, ICV-LNPCPs can be effectively and safely managed by EMR, independent of lesion complexity. Most patients experience excellent outcomes and avoid surgery.
由于回盲瓣（ICV）处大型无蒂结直肠息肉（ICV-LNPCP）具有独特的解剖学特征，其内镜管理仍然具有挑战性，长期结果不如不涉及 ICV 的无蒂结直肠息肉。我们旨在评估内镜下黏膜切除术（EMR）中技术创新和进步对 ICV-LNPCP 的影响。
对 20mm 以上的大型无蒂结直肠息肉的前瞻性观察队列中 ICV-LNPCP 的 EMR 表现进行回顾性评估。通过临床成功（在初次 EMR 时完全切除所有息肉组织并避免手术）和首次随访结肠镜检查时的复发来衡量疗效。考虑到技术创新的采用，对历史队列（2008 年 9 月至 2016 年 4 月）和当代队列（2016 年 5 月至 2020 年 10 月）进行了比较。通过记录术中出血、迟发性出血、深部壁损伤和迟发性穿孔的频率来评估安全性。
2008 年 9 月至 2020 年 10 月期间，有 142 个 ICV-LNPCP 被转介进行 EMR。ICV-LNPCP 的中位大小为 35mm（四分位距 25-50mm）。在比较当代（n=66）和历史队列（n=76）的 ICV-LNPCP 时，临床成功率（93.9% vs. 77.6%，P=0.006）和复发率（4.6% vs. 21.0%，P=0.019）有显著差异。
随着技术的进步，ICV-LNPCP 可以通过 EMR 有效且安全地进行管理，而与病变的复杂性无关。大多数患者都能获得良好的结果并避免手术。
