Williams Thomas J, Mickenbecker Matthew, Smith Nicholas, Bhasker Vikas, Rubtsov Denis, Jones Andrew, Sabanathan Jeevithan
Department of Gastroenterology, Logan Hospital, Brisbane, Queensland, Australia; School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
Department of Gastroenterology, Logan Hospital, Brisbane, Queensland, Australia.
Gastrointest Endosc. 2025 Jan;101(1):178-183. doi: 10.1016/j.gie.2024.08.008. Epub 2024 Aug 13.
There is growing evidence for the role of cold piecemeal EMR (C-EMR) in the treatment of colorectal lesions ≥10 mm. However, it is unclear if C-EMR is equally efficacious for all histologic subtypes and sizes. This retrospective study compares the efficacy and safety of C-EMR in the resection of medium (10-19 mm) and large (≥20 mm) serrated and adenomatous lesions.
A retrospective analysis was performed of Paris IIa colonic lesions resected by using a C-EMR technique over a 3.5-year period at our center.
C-EMR was performed for 242 lesions in 151 patients. Lesion size ranged between 10 and 50 mm, with a median size of 20 mm. Ninety-five polyps were adenomatous, with 147 sessile serrated lesions (SSLs). At 6-month surveillance colonoscopy, the combined recurrence rate was 6.2%. Adenomas ≥20 mm showed a higher rate of recurrence (16.1%) compared with large SSLs (4.1%), medium adenomas (3.0%), and medium SSLs (1.4%). There were no adverse events reported after C-EMR.
C-EMR seems to be less effective for the resection of large adenomas compared with medium adenomas or large SSLs. C-EMR is equally safe for all lesion sizes and histology.
越来越多的证据表明，冷圈套息肉切除术（C-EMR）在治疗直径≥10mm的结直肠病变中发挥着作用。然而，目前尚不清楚C-EMR对所有组织学亚型和大小的病变是否同样有效。本回顾性研究比较了C-EMR切除中等大小（10-19mm）和大尺寸（≥20mm）锯齿状及腺瘤性病变的疗效和安全性。
对本中心在3.5年期间采用C-EMR技术切除的巴黎IIa型结肠病变进行回顾性分析。
151例患者的242个病变接受了C-EMR治疗。病变大小在10至50mm之间，中位大小为20mm。其中95个息肉为腺瘤性，147个为无蒂锯齿状病变（SSLs）。在6个月的结肠镜监测中，联合复发率为6.2%。与大尺寸SSLs（4.1%）、中等大小腺瘤（3.0%）和中等大小SSLs（1.4%）相比，≥20mm的腺瘤复发率更高（16.1%）。C-EMR术后未报告不良事件。
与中等大小腺瘤或大尺寸SSLs相比，C-EMR切除大腺瘤的效果似乎较差。C-EMR对所有病变大小和组织学类型同样安全。
