Division of Gastroenterology,Montreal University Hospital Research Center (CRCHUM), Montreal, Canada.
Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Canada.
Scand J Gastroenterol. 2024 Jan-Jun;59(1):112-117. doi: 10.1080/00365521.2023.2257824. Epub 2023 Dec 26.
Serrated lesions (SLs) including traditional serrated adenomas (TSA), large hyperplastic polyps (HP) and sessile serrated lesions (SSLs) are associated with high incomplete resection rates. Margin ablation combined with EMR (EMR-T) has become routine to reduce local recurrence while cold snare polypectomy (CSP) is becoming recognized as equally effective for large SLs. Our aim was to evaluate local recurrence rates (LRR) and the use of margin ablation in preventing recurrence in a retrospective cohort study.
Patients undergoing resection of ≥15 mm colorectal SLs from 2010-2022 were identified through a pathology database and electronic medical records search. Hereditary CRC syndromes, first follow-up > 18 months or no follow-up, surgical resection were excluded. Primary outcome was LRRs (either histologic or visual) during the first 18-month follow-up. Secondary outcomes were LRRs according to size, and resection technique.
191 polyps in 170 patients were resected (59.8% women; mean age, 65 years). The mean size of polyps was 22.4 mm, with 107 (56.0%) ≥20 mm. 99 polyps were resected with EMR, 39 with EMR-T, and 26 with CSP. Mean first surveillance was 8.2 mo. Overall LRR was 18.8% (36/191) (16.8% for ≥20 mm, 17.9% for ≥30 mm). LRR was significantly lower after EMR-T when compared with EMR (5.1% vs. 23.2%; = 0.013) or CSP (5.1% vs. 23.1%; = 0.031). There was no difference in LRR between EMR without margin ablation and CSP ( = 0.987).
The local recurrence rate for SLs ≥15 mm is high with 18.8% overall recurrence. EMR with thermal ablation of the margins is superior to both no ablation and CSP in reducing LRRs.
锯齿状病变（SLs）包括传统锯齿状腺瘤（TSA）、大型增生性息肉（HP）和无蒂锯齿状病变（SSLs），与不完全切除率高有关。边缘消融联合内镜黏膜切除术（EMR-T）已成为常规方法，以降低局部复发率，而冷圈套息肉切除术（CSP）已被认为对大型 SLs 同样有效。我们的目的是在一项回顾性队列研究中评估局部复发率（LRR）和边缘消融在预防复发中的作用。
通过病理数据库和电子病历搜索，确定 2010 年至 2022 年间接受≥15mm 结直肠 SL 切除术的患者。排除遗传性 CRC 综合征、首次随访>18 个月或无随访、手术切除。主要结局是在首次 18 个月随访期间的 LRR（组织学或视觉）。次要结局是根据大小和切除技术的 LRR。
170 例患者共切除 191 个息肉（59.8%为女性；平均年龄 65 岁）。息肉平均大小为 22.4mm，其中 107 个（56.0%）≥20mm。99 个息肉行 EMR 切除，39 个行 EMR-T 切除，26 个行 CSP 切除。首次监测平均为 8.2 个月。总 LRR 为 18.8%（36/191）（≥20mm 为 16.8%，≥30mm 为 17.9%）。与 EMR（5.1%比 23.2%； = 0.013）或 CSP（5.1%比 23.1%； = 0.031）相比，EMR-T 后 LRR 显著降低。EMR 无边缘消融与 CSP 之间的 LRR 无差异（ = 0.987）。
≥15mm 的 SLs 局部复发率较高，总体复发率为 18.8%。与无消融和 CSP 相比，热消融边缘的 EMR 可降低 LRR。
