Hospital Santa Casa de Caridade, Serviço de Endoscopia, Bagé, RS, Brasil.
Pontifícia Universidade Católica do Rio Grande do Sul, Departamento de Endoscopia, Porto Alegre, RS, Brasil.
Arq Gastroenterol. 2023 Oct-Dec;60(4):470-477. doi: 10.1590/S0004-2803.23042023-115.
Polypectomy is an important treatment option for preventing colorectal cancer. Incomplete polyp resection (IPR) is re-cognized as a risk factor for interval cancer.
The primary objective was to evaluate the complete polyp resection (CPR) rate for cold snare polypectomy (CSP) in small non-pedunculated polyps and, secondarily, specimen retrieval and complication rates.
We prospectively evaluated 479 polyps <10 mm removed by CSP in 276 patients by an inexperienced endoscopist.
A total of 476 polyps (99.4%) were resected en bloc. A negative margin (classified as CPR) was observed in 435 polyps (90.8%). An unclear or positive margin (classified as IPR) was observed in 43 cases (9.0%) and 1 case (0.2%), respectively, for an overall IPR rate of 9.2% (44/479). The IPR rate was 12.2% in the first half of cases and 5.9% in the second half (P=0.02). Dividing into tertiles, the IPR rate was 15.0% in the first tertile, 6.9% in the second tertile, and 5.7% in the third tertile (P=0.01). Dividing into quartiles, the IPR rate was 15.8% in the first quartile and 5.9% in the fourth quartile (P=0.03). The IPR rate was 6.3% for type 0-IIa lesions and 14.1% for type 0-Is lesions (P=0.01). For serrated and adenomatous lesions, the IPR rate was 9.2%. Specimen retrieval failed in 3.6% of cases. Immediate bleeding (>30 s) occurred in 1 case (0.2%), treated with argon plasma coagulation. No delayed bleeding or perforation occurred.
CSP is a safe technique that provides good results for the resection of small non-pedunculated polyps, with a short learning curve.
息肉切除术是预防结直肠癌的重要治疗选择。不完全息肉切除（IPR）被认为是间隔期癌症的一个危险因素。
主要目的是评估冷圈套息肉切除术（CSP）在小无蒂息肉中完全息肉切除（CPR）的比率，其次是标本取出和并发症的发生率。
我们前瞻性评估了 276 名经验不足的内镜医生切除的 479 个<10mm 的无蒂息肉。
共切除 476 个息肉（99.4%）为整块切除。435 个息肉（90.8%）边缘阴性（定义为 CPR）。43 例（9.0%）和 1 例（0.2%）的边缘不清晰或阳性（定义为 IPR），总 IPR 率为 9.2%（44/479）。前半部分病例的 IPR 率为 12.2%，后半部分病例的 IPR 率为 5.9%（P=0.02）。分为三分位，第 1 三分位 IPR 率为 15.0%，第 2 三分位 IPR 率为 6.9%，第 3 三分位 IPR 率为 5.7%（P=0.01）。分为四分位，第 1 四分位 IPR 率为 15.8%，第 4 四分位 IPR 率为 5.9%（P=0.03）。0-IIa 型病变的 IPR 率为 6.3%，0-Is 型病变的 IPR 率为 14.1%（P=0.01）。锯齿状和腺瘤性病变的 IPR 率为 9.2%。3.6%的病例标本无法取出。1 例（0.2%）发生即刻出血（>30 秒），采用氩等离子凝固治疗。无迟发性出血或穿孔。
CSP 是一种安全的技术，用于切除小无蒂息肉具有良好的效果，学习曲线较短。
