Department of Colorectal Surgery, King's College Hospital, Denmark Hill, London SE5 9RS, United Kingdom.
Gastrointest Endosc Clin N Am. 2023 Jan;33(1):83-97. doi: 10.1016/j.giec.2022.08.001.
Multimodal assessment of colorectal polyps is needed before decision-making for endoscopic mucosal resection or endoscopic submucosal dissection (ESD). Assessment should include morphology according to Paris classification, magnification endoscopy for vascular pattern, and Kudo pit pattern analysis. ESD should be offered to patients that have Vi pit pattern, lateral spreading tumors (LST) granular multinodular and LST nongranular, lesions with fibrosis and those in patients with inflammatory bowel disease. A defined strategy for resection and planning is crucial for successful and efficient resection with a clear audit of outcomes aiming for a perforation and bleeding rate of less than 1% and R0 resection greater than 90%.
在决定是否进行内镜黏膜切除术（endoscopic mucosal resection，EMR）或内镜黏膜下剥离术（endoscopic submucosal dissection，ESD）之前，需要对结直肠息肉进行多模态评估。评估应包括根据巴黎分类的形态学、放大内镜下的血管模式以及 Kudo 凹陷模式分析。应向具有 Vi 凹陷模式、侧向扩张性肿瘤（laterally spreading tumors，LST）颗粒状多结节和非颗粒状 LST、有纤维化的病变以及炎症性肠病患者提供 ESD。对于成功和高效的切除，明确的切除和规划策略至关重要，并且需要对结果进行明确的审核，以将穿孔和出血率控制在 1%以下，R0 切除率大于 90%。
