Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia; Medical School, University of Sydney, Westmead, New South Wales, Australia; Department of Gastroenterology and Hepatology, University Hospital of Ghent, Ghent, Belgium; Faculty of Health Sciences, University of Ghent, Ghent, Belgium.
Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia.
Gastrointest Endosc. 2024 Sep;100(3):501-509. doi: 10.1016/j.gie.2024.01.030. Epub 2024 Jan 25.
Residual or recurrent adenoma (RRA) detected during surveillance is the major limitation of EMR. The pathogenesis of RRA is unknown, although thermal ablation of the post-endoscopic resection defect (PED) margin reduces RRA. We aimed to identify a feature within the PED that could be associated with RRA.
Between January 2017 and July 2020, detailed prospective procedural data on all EMR procedures performed at a single center were retrospectively analyzed. At the completion of EMR, the PED was systematically examined for features of incomplete mucosal layer excision (IME). This was defined as a demarcated area within the PED bordered by a white electrocautery ring and containing endoscopically identifiable features suggesting incomplete resection of the mucosa including lacy capillaries and/or visible fibers of the muscularis mucosae. Areas of IME were reinjected and re-excised by snare and submitted separately for blinded specialist GI pathologist review.
EMR was performed for 508 large nonpedunculated colorectal polyps (LNPCPs) (median size, 35 mm). In 10 PEDs (2.0%), an area of IME was identified and excised. Histopathologic examination of areas of suspected IME demonstrated muscularis mucosae in 9 of 10 (90%), residual lamina propria in 9 of 10 (90.0%), and residual adenoma in 5 of 10 (50.0%). No RRA was detected during follow-up after re-excision of IME.
We report the novel finding of IME within the PED after EMR of LNPCPs. IME may contain microscopic residual adenoma and therefore is a risk for RRA during follow-up. After completion of EMR, the PED should be carefully evaluated. If IME is found, it should be excised. (Clinical trial registration number: NCT01368289 and NCT02000141.).
在监测期间检测到的残留或复发性腺瘤（RRA）是内镜黏膜下剥离术（EMR）的主要局限性。RRA 的发病机制尚不清楚，尽管对内镜黏膜下剥离术后缺损（PED）边缘进行热消融可以降低 RRA 的发生。我们旨在确定 PED 内的一个特征，该特征可能与 RRA 相关。
本研究回顾性分析了 2017 年 1 月至 2020 年 7 月在单中心进行的所有 EMR 手术的详细前瞻性手术数据。EMR 完成后，系统地检查 PED 是否存在不完全黏膜层切除（IME）的特征。该定义为 PED 边界内的一个界定区域，边界由白色电烙环环绕，并包含内镜下可识别的提示黏膜不完全切除的特征，包括花边毛细血管和/或可见的黏膜肌纤维。对 IME 区域进行重新注射并用圈套器再次切除，并分别提交给盲法胃肠病学专家进行审查。
共对 508 个大的无蒂结直肠息肉（LNPCP）（中位大小 35mm）进行了 EMR。在 10 个 PED 中（2.0%），发现并切除了 IME 区域。对疑似 IME 区域的组织病理学检查显示，9/10（90%）存在黏膜肌层，9/10（90.0%）存在固有层残留，5/10（50.0%）存在残留腺瘤。在 IME 再次切除后的随访中未发现 RRA。
我们报告了 EMR 切除 LNPCP 后 PED 内出现 IME 的新发现。IME 内可能含有微观残留腺瘤，因此在随访期间存在 RRA 的风险。EMR 完成后，应仔细评估 PED。如果发现 IME，应予以切除。（临床试验注册号：NCT01368289 和 NCT02000141.）
