Department of Gastroenterology and Hepatology, Westmead Hospital.
Department of Gastroenterology, Northern Health.
Curr Opin Gastroenterol. 2024 Sep 1;40(5):355-362. doi: 10.1097/MOG.0000000000001041. Epub 2024 May 27.
Large nonpedunculated colorectal polyps ≥ 20 mm (LNPCPs) comprise 1% of all colorectal lesions. LNPCPs are more likely to contain advanced histology such as high-grade dysplasia and submucosal invasive cancer (SMIC). Endoscopic resection is the first-line approach for management of these lesions. Endoscopic resection options include endoscopic mucosal resection (EMR), cold-snare EMR (EMR), endoscopic submucosal dissection (ESD) and endoscopic full-thickness resection (EFTR). This review aimed to critically evaluate current endoscopic resection techniques.
Evidence-based selective resection algorithms should inform the most appropriate endoscopic resection technique. Most LNPCPs are removed by conventional EMR but there has been a trend toward C-EMR for endoscopic resection of LNPCPs. More high-quality trials are required to better define the limitations of C-EMR. Advances in our understanding of ESD technique, has clarified its role within the colorectum. More recently, the development of a full thickness resection device (FTRD) has allowed the curative endoscopic resection of select lesions.
Endoscopic resection should be regarded as the principle approach for all LNPCPs. Underpinned by high-quality research, endoscopic resection has become more nuanced, leading to improved patient outcomes.
直径大于 20 毫米的无蒂结直肠大息肉（LNPCP）占所有结直肠病变的 1%。LNPCP 更有可能包含高级别组织学特征，如高级别异型增生和黏膜下浸润癌（SMIC）。内镜下切除是这些病变的首选治疗方法。内镜下切除的选择包括内镜黏膜切除术（EMR）、冷圈套 EMR（C-EMR）、内镜黏膜下剥离术（ESD）和内镜全层切除术（EFTR）。本综述旨在批判性评估当前的内镜下切除技术。
基于循证的选择性切除算法应告知最合适的内镜下切除技术。大多数 LNPCP 通过常规 EMR 切除，但对于 LNPCP 的内镜切除，C-EMR 的应用呈上升趋势。需要更多高质量的试验来更好地确定 C-EMR 的局限性。我们对 ESD 技术的理解的进步，明确了其在结直肠中的作用。最近，全层切除装置（FTRD）的发展允许对特定病变进行有治愈作用的内镜下切除。
内镜下切除应被视为所有 LNPCP 的主要治疗方法。在高质量研究的支持下，内镜下切除已经变得更加精细，从而改善了患者的治疗效果。
