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大回盲瓣病变是否可以通过先进的内镜治疗来避免肠切除?

Are large ileocecal valve lesions amenable with advanced endoscopic management to avoid bowel resection?

机构信息

Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.

出版信息

Surg Endosc. 2023 Jul;37(7):5320-5325. doi: 10.1007/s00464-023-10014-z. Epub 2023 Mar 29.

Abstract

INTRODUCTION

Mucosal lesions located at the ileocecal valve may be challenging for endoscopic intervention because of angulated anatomy and a thinner wall with narrower lumen when compared to other locations of the bowel. This study aimed to evaluate the management and outcomes of ileocecal valve lesions treated endoscopically.

MATERIAL AND METHODS

Patients with mucosal neoplasms involving the ileocecal valve managed with advanced endoscopy at a quaternary care hospital between 2011 and 2021 were included from a prospectively collected database. Patient demographics, lesion characteristics, complications, and outcomes are reported.

RESULTS

From 1005 lesions, 80 patients (8%) underwent resection for neoplasms involving ileocecal valve by ESD (n = 38), hybrid ESD (n = 38), EMR (n = 2), and CELS (n = 2). The median age of the study group was 63(37-84) years, and 50% of patients were female. The median lesion size was 34 mm (5-75). The mean procedure time was 66 ± 44 min(range:18-200). The dissection was completed as piecemeal in 41(51%) patients and 35(44%) had en-bloc dissection. Seven(8%) endoscopic interventions required conversion to laparoscopic surgery due to inability to lift the mucosa(n = 4) and perforation(n = 3). No immediate bleeding occurred in the study group. Five patients had late rectal bleeding and two were admitted with post-polypectomy pain within 30 days of intervention. Pathology revealed 4(5%) adenocarcinomas, 33(41.2%) tubular adenomas, 30(37.8%) tubulovillous adenomas, and 5(6.2%) sessile serrated adenomas. Sixty-seven (84.5%) patients completed at least one follow-up colonoscopy and were followed for a median of 11(0-64) months. Six (8.9%) patients had recurrence and were managed with subsequent endoscopic removal.

CONCLUSION

Advanced endoscopy can be safely and effectively performed for the management of ileocecal valve polyps with low complication and acceptable recurrence rates. Advanced endoscopy promises an alternative approach to oncologic ileocecal resection while attaining organ preservation. Our study demonstrates the impact of advanced endoscopy for the treatment of mucosal neoplasms involving ileocecal valve.

摘要

介绍

与肠其他部位相比,回盲瓣的黏膜病变由于解剖学上的角度和更薄的壁及更窄的管腔,内镜干预可能具有挑战性。本研究旨在评估内镜治疗回盲瓣病变的管理和结果。

材料和方法

从 2011 年至 2021 年,在一家四级保健医院,从一个前瞻性收集的数据库中纳入了接受高级内镜治疗的涉及回盲瓣的黏膜肿瘤患者。报告患者的人口统计学、病变特征、并发症和结果。

结果

1005 个病变中,80 例(8%)患者因回盲瓣肿瘤接受内镜黏膜下剥离术(ESD,n=38)、混合 ESD(n=38)、内镜黏膜切除术(EMR,n=2)和经黏膜下隧道内镜肿瘤切除术(CELS,n=2)治疗。研究组的中位年龄为 63(37-84)岁,50%为女性。中位病变大小为 34mm(5-75)。平均手术时间为 66±44min(范围:18-200)。41(51%)例患者整块切除,35(44%)例患者分块切除。7(8%)例内镜干预因无法提起黏膜(n=4)和穿孔(n=3)需要转为腹腔镜手术。研究组无即时出血。5 例患者术后出现迟发性直肠出血,2 例患者在干预后 30 天内因息肉切除后疼痛而住院。病理显示 4(5%)例腺癌、33(41.2%)例管状腺瘤、30(37.8%)例管状绒毛状腺瘤和 5(6.2%)例无蒂锯齿状腺瘤。67(84.5%)例患者完成了至少一次随访结肠镜检查,随访时间中位数为 11(0-64)个月。6(8.9%)例患者复发,随后行内镜下切除。

结论

高级内镜可安全有效地治疗回盲瓣息肉,并发症发生率低,复发率可接受。高级内镜在实现器官保留的同时,为回盲瓣肿瘤的治疗提供了一种替代的方法。我们的研究证明了高级内镜在治疗涉及回盲瓣的黏膜肿瘤方面的作用。

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