Jakobs Johanna Katharina, Zumblick Malte, von Gerlach Susanne, Stathopoulos Petros, Glas Sebastian, Denkert Carsten, Denzer Ulrike Walburga
Gastroenterology, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Germany.
Pathology, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Germany.
Endosc Int Open. 2024 Dec 6;12(12):E1437-E1446. doi: 10.1055/a-2427-1948. eCollection 2024 Dec.
For pedunculated colon polyps, en bloc resection with inclusion of the polyp stalk is necessary to yield an accurate histologic staging. This can be challenging in cases of a large polyp and/or broad stalk using conventional snare resection. We evaluated the feasibility of endoscopic submucosal dissection (ESD) for large pedunculated polyps with broad stalks. Between February 2019 and November 2021 all patients with large pedunculated polyps defined as polyp diameter ≥ 20 mm and or a broad stalk > 5 mm were enrolled in the study. All polyps were resected in ESD technique with dissection of the polyp stalk at the base after injection. Twenty-five patients (male = 18, age mean: 67 years) were included. En bloc resection was achieved in 100% of the patients (25/25 polyps). Polyps were mainly located in the sigmoid (n = 19) and rectum (n = 3). Median polyp size was 30×25×17 mm. Histologic examination revealed the following results: adenoma low-grade intraepithelial neoplasia (LG-IEN): nine; high-grade intraepithelial neoplasia (HG-IEN): seven; pTis: three; adenoarcinoma: five (G1, pT1, L0, V0, Haggitt 3: 2/G2, pT1, L0, V0, Haggitt 3:2/G3, pT1, Bd3, V1, Haggitt 4: 1); other: 1. R0 resection rate was 100% and the curative resection rate yielded 96% (24/25) without severe adverse events. ESD achieved high en bloc and R0 resection rates for large pedunculated polyps. In our collective, up to 32% of polyps already had adenocarcinoma, resulting in a high curative resection rate due to complete resection and subsequently accurate risk classification.
对于有蒂结肠息肉，完整切除并包含息肉蒂对于获得准确的组织学分期是必要的。在使用传统圈套器切除大息肉和/或宽蒂息肉的情况下，这可能具有挑战性。我们评估了内镜黏膜下剥离术（ESD）用于治疗宽蒂大的有蒂息肉的可行性。2019年2月至2021年11月期间，所有息肉直径≥20 mm和/或宽蒂>5 mm的宽蒂大的有蒂息肉患者均纳入本研究。所有息肉均采用ESD技术切除，注射后在基底部剥离息肉蒂。纳入25例患者（男性18例，平均年龄67岁）。所有患者（25个息肉）均实现了完整切除。息肉主要位于乙状结肠（n = 19）和直肠（n = 3）。息肉中位数大小为30×25×17 mm。组织学检查结果如下：腺瘤低级别上皮内瘤变（LG-IEN）：9例；高级别上皮内瘤变（HG-IEN）：7例；pTis：3例；腺癌：5例（G1，pT1，L0，V0，哈格蒂3级：2例/G2，pT1，L0，V0，哈格蒂3级：2例/G3，pT1，Bd3，V1，哈格蒂4级：1例）；其他：1例。R0切除率为100%，根治性切除率为96%（24/25），且无严重不良事件。ESD对于宽蒂大的有蒂息肉实现了高完整切除率和R0切除率。在我们的研究群体中，高达32%的息肉已发生腺癌，由于完整切除及随后准确的风险分类，导致根治性切除率较高。
