冷圈套息肉切除术与冷内镜黏膜切除术治疗小的结直肠息肉：一项多中心随机对照试验。
Cold snare polypectomy versus cold endoscopic mucosal resection for small colorectal polyps: a multicenter randomized controlled trial.
机构信息
Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Division of Gastroenterology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
出版信息
Surg Endosc. 2023 May;37(5):3789-3795. doi: 10.1007/s00464-023-09875-1. Epub 2023 Jan 23.
BACKGROUND
Cold snare polypectomy (CSP) is recommended for the resection of small colorectal polyps. However, few studies have investigated the efficacy of cold endoscopic mucosal resection (cold EMR) for small polyps. Thus, the aim of this study was to investigate the efficacy and safety of cold EMR compared with CSP for small colorectal polyps.
METHODS
This was a multicenter, randomized trial conducted in three tertiary centers from January 2018 to February 2021. Patients with polyps sized 6-10 mm were randomized to CSP or cold EMR group. After polypectomy, two additional biopsies were performed to assess the completeness of resection. The primary outcome was complete polyp resection rate. Secondary outcomes were total procedure time and rate of adverse events such as immediate bleeding, delayed bleeding, and perforation.
RESULTS
A total of 444 polyps in 327 patients were assessed and randomly assigned to each group. Of those, 425 polyps were finally analyzed based on pathology results. The complete resection rate was not significantly different between cold EMR and CSP groups (91.9% vs 89.8%, p = 0.24). However, the total procedure time was significantly increased in cold EMR (87.6 s vs. 45.8 s, p < 0.001). The rate of polypectomy adverse events was not significantly different between the two groups. No patient had massive bleeding or perforation.
CONCLUSIONS
There was no difference in complete resection rate or adverse events between CSP and cold EMR. However, CSP reduced the total procedure time.
背景
冷圈套息肉切除术（CSP）被推荐用于切除小的结直肠息肉。然而，很少有研究调查冷内镜黏膜切除术（冷 EMR）治疗小息肉的疗效。因此，本研究旨在比较冷 EMR 和 CSP 治疗小的结直肠息肉的疗效和安全性。
方法
这是一项多中心、随机试验，于 2018 年 1 月至 2021 年 2 月在三个三级中心进行。息肉大小为 6-10mm 的患者被随机分配到 CSP 或冷 EMR 组。息肉切除后，再进行两次额外的活检以评估切除的完整性。主要结局是完全切除息肉的比例。次要结局是总手术时间和不良事件的发生率，如即刻出血、延迟出血和穿孔。
结果
共评估了 327 例患者的 444 个息肉，并将其随机分配到每组。其中，根据病理结果最终分析了 425 个息肉。冷 EMR 和 CSP 组的完全切除率无显著差异（91.9%比 89.8%，p=0.24）。然而，冷 EMR 的总手术时间明显延长（87.6s 比 45.8s，p<0.001）。两组的息肉切除术不良事件发生率无显著差异。无患者发生大出血或穿孔。
结论
CSP 和冷 EMR 组在完全切除率或不良事件发生率方面无差异。然而，CSP 缩短了总手术时间。
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