Gordon Stuart R, Eichenwald Lauren S, Systrom Hannah K
Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, NH, Lebanon.
Surg Open Sci. 2024 Jul 4;20:156-168. doi: 10.1016/j.sopen.2024.06.012. eCollection 2024 Aug.
The implementation of screening colonoscopy with polyp removal has significantly decreased mortality rates associated with colorectal cancer (CRC), although it remains a major cause of cancer-related deaths globally. CRC typically originates from adenomatous polyps, and increased removal of these growths has led to reduced CRC incidence and mortality. Endoscopic polypectomy techniques, including hot and cold snare polypectomy, play a pivotal role in this process. While both methods are effective for small polyps (<10 mm), recent evidence favors cold snare polypectomy due to its superior safety profile and comparable complete resection rates. Large polyps (>10 mm), particularly those with advanced features, pose increased cancer risks and often require meticulous assessment and advanced endoscopic techniques, including endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), for resection. This chapter also provides a practical overview of endoscopic techniques for managing colonic obstructions and pericolonic fluid collections, detailing their indications, advantages, disadvantages, and complications. The goal is to improve understanding and application in clinical practice. Additionally, we provide a summary of endoscopic closure techniques that have revolutionized the management of perforations and fistulas, offering safe and effective alternatives to surgery.
实施筛查性结肠镜检查并切除息肉已显著降低了结直肠癌（CRC）相关的死亡率，尽管它仍是全球癌症相关死亡的主要原因。CRC通常起源于腺瘤性息肉，增加对这些肿物的切除已导致CRC发病率和死亡率降低。内镜下息肉切除术，包括热圈套息肉切除术和冷圈套息肉切除术，在此过程中起着关键作用。虽然这两种方法对小息肉（<10毫米）均有效，但最近的证据表明冷圈套息肉切除术更具优势，因其安全性更高且完全切除率相当。大息肉（>10毫米），尤其是那些具有高级别特征的息肉，癌症风险增加，通常需要细致评估并采用先进的内镜技术，包括内镜黏膜切除术（EMR）和内镜黏膜下剥离术（ESD）进行切除。本章还对处理结肠梗阻和结肠周围液体积聚的内镜技术进行了实用概述，详细介绍了它们的适应证、优点、缺点及并发症。目的是提高临床实践中的理解和应用。此外，我们总结了彻底改变穿孔和瘘管治疗方式的内镜闭合技术，为手术提供了安全有效的替代方案。
