Katagiri Atsushi, Suzuki Norihiro, Nakatani Shinya, Kikuchi Kazuo, Fujiwara Takahisa, Gocho Toshihiko, Konda Kenichi, Inoki Kazuya, Yamamura Fuyuhiko, Yoshida Hitoshi
Department of Medicine, Division of Gastroenterology, Showa University School of Medicine, Tokyo, JPN.
Cureus. 2023 May 17;15(5):e39164. doi: 10.7759/cureus.39164. eCollection 2023 May.
Immediate bleeding after cold snare polypectomy (CSP) for colorectal polyps might interfere with confirmation of residuals and prolong the time required for resection. We investigated whether submucosal epinephrine-added saline injection reduces the time required for the CSP procedure.
We conducted a single-center, prospective, randomized controlled trial (clinical trial registration number: UMIN000046770). Patients with colorectal polyps ≤ 10 mm were randomly allocated to either CSP with epinephrine-added submucosal injection (CEMR group) or conventional CSP (CSP group). The primary outcome was the time required for resection defined as the time from the initiation of resection (the first insertion of the snare in the CSP group or the injection needle in the CEMR group) to the end of resection (confirming complete resection endoscopically after recognizing the cessation of immediate bleeding) in each lesion, and the secondary outcome was the time to spontaneous cessation of immediate bleeding after resection defined as the time from ensnaring the lesion to confirming the spontaneous cessation of immediate bleeding.
A total of 126 patients were randomly assigned. Finally, 261 lesions in 118 patients (CEMR group, n = 59; CSP group, n = 59) were analyzed. The time required for resection calculated using the least-square mean was significantly shorter in the CEMR group (106.3 s, 95% CI 97.5 to 115.4 s) than in the CSP group (130.9 s, 95% CI 121.2 to 140.7 s) (P < 0.001). The time to spontaneous cessation of immediate bleeding was also significantly shorter in the CEMR group (20.4 s, 95% CI 14.3 to 26.5 s) than in the CSP group (74.2 s, 95% CI 67.6 to 80.7 s) (P < 0.001). Neither group had cases requiring hemostasis, perforation, or delayed bleeding.
CEMR shortened the time for resection by shortening the time to cessation of immediate bleeding compared with conventional CSP in colorectal polyps ≤ 10 mm.
结直肠息肉冷圈套息肉切除术（CSP）后立即出血可能会干扰对残留情况的确认，并延长切除所需时间。我们研究了黏膜下注射含肾上腺素的生理盐水是否能缩短CSP手术所需时间。
我们开展了一项单中心、前瞻性、随机对照试验（临床试验注册号：UMIN000046770）。将结直肠息肉直径≤10 mm的患者随机分为黏膜下注射肾上腺素的CSP组（CEMR组）或传统CSP组（CSP组）。主要结局是每个病变的切除所需时间，定义为从切除开始（CSP组为圈套器首次插入，CEMR组为注射针插入）到切除结束（在确认立即出血停止后通过内镜确认完全切除）的时间，次要结局是切除后立即出血自然停止的时间，定义为从套住病变到确认立即出血自然停止的时间。
共126例患者被随机分组。最终，对118例患者的261个病变进行了分析（CEMR组，n = 59；CSP组，n = 59）。使用最小二乘均数计算的切除所需时间在CEMR组（106.3秒，95%可信区间97.5至115.4秒）显著短于CSP组（130.9秒，95%可信区间121.2至140.7秒）（P < 0.001）。CEMR组立即出血自然停止的时间也显著短于CSP组（20.4秒，95%可信区间14.3至26.5秒）（74.2秒，95%可信区间67.6至80.7秒）（P < 0.001）。两组均无需要止血、穿孔或延迟出血的病例。
与传统CSP相比，对于直径≤10 mm的结直肠息肉，CEMR通过缩短立即出血停止的时间缩短了切除时间。
