Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia; Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia.
Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia; Departamento de Gastrenterologia e Hepatologia, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.
Gastrointest Endosc. 2024 Mar;99(3):428-436. doi: 10.1016/j.gie.2023.10.034. Epub 2023 Oct 17.
Although conventional hot snare resection (CR) of laterally spreading lesions of the major papilla (LSL-Ps) is effective, it can be associated with delayed bleeding in upward of 25% of cases. Given the excellent safety profile of cold snare polypectomy in the colorectum, we investigated the efficacy and safety of a novel hybrid resection (HR) technique for LSL-P management, consisting of hot snare papillectomy plus cold snare resection of the laterally spreading component.
A prospective cohort of patients underwent HR in a tertiary referral center over 60 months until December 2022. This cohort was compared with a historical cohort of patients who underwent CR at the same institution over 120 months until August 2017. The primary outcomes were recurrence and bleeding.
Twenty patients underwent HR (14 female; mean age 65.2 ± 12.2 years). Median lesion size was 30 mm (interquartile range, 25.0-47.5 mm). Recurrent or residual adenoma (RRA) was greater with HR (58.8% [n = 10] vs 29.8% [n = 14]; P = .034). The odds ratio for recurrence was 3.6 times (95% CI, 1.2-11.0) higher with HR (P = .027). RRA was multifocal in 4 (40%) and had a composite RRA volume >10 mm in 7 (70%). The median number of procedures required to treat RRA was higher with HR (4 vs 1, P = .002). There was no difference between CR and HR for intraprocedural bleeding (41.1% [n = 23] vs 25% [n = 5]; P = .587) or delayed bleeding (25.0% vs 10.0%, P = .211). There were no perforations.
The novel HR technique for LSL-P management is associated with a high rate of RRA that is recalcitrant to treatment, without mitigating the risk of intraprocedural or delayed bleeding. Therefore, CR should remain the mainstay management option for treating patients with an LSL-P. (Clinical trial registration number: NCT02306603.).
尽管传统的侧向伸展性病变（LSL-Ps）热圈套切除术（CR）有效，但仍有 25%以上的病例会出现延迟性出血。鉴于冷圈套息肉切除术在结直肠中的出色安全性，我们研究了一种新型混合切除术（HR）技术治疗 LSL-P 的疗效和安全性，该技术由热圈套乳头切除术加侧向伸展成分的冷圈套切除术组成。
在 2017 年 8 月之前的 120 个月期间，在同一机构接受 CR 的历史队列中，前瞻性地对三级转诊中心的患者进行 HR 治疗。该队列与 60 个月期间接受 HR 治疗的 20 名女性患者（平均年龄 65.2±12.2 岁）进行了比较。中位病变大小为 30mm（四分位距，25.0-47.5mm）。HR 后复发或残留腺瘤（RRA）更多（58.8%[n=10] vs. 29.8%[n=14]；P=0.034）。HR 的 RRA 复发比值比为 3.6 倍（95%CI，1.2-11.0）（P=0.027）。4 例（40%）RRA 为多灶性，7 例（70%）RRA 复合体积＞10mm。HR 治疗 RRA 需要的手术次数中位数更高（4 次 vs. 1 次，P=0.002）。CR 和 HR 之间术中出血无差异（41.1%[n=23] vs. 25%[n=5]；P=0.587）或延迟性出血（25.0% vs. 10.0%，P=0.211）。无穿孔。
LSL-P 管理的新型 HR 技术与 RRA 发生率高相关，且对治疗具有抵抗性，并没有降低术中或延迟性出血的风险。因此，CR 应仍然是治疗 LSL-P 患者的主要治疗选择。（临床试验注册号：NCT02306603.）
