Predictive factors for complications in endoscopic resection of large colorectal lesions: a multicenter prospective study
Predictive factors for complications in endoscopic resection of large colorectal lesions: a multicenter prospective study
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DOI：
10.1007/s00464-014-3799-9
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发表时间：
2015-05-01
影响因子：
3.1
通讯作者：
Sugihara, Kenichi
中科院分区：
文献类型：
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作者：
Wada, Yoshiki;Kudo, Shin-ei;Sugihara, Kenichi
传统的内镜切除术（CER）包括息肉切除术和内镜下粘膜切除术。与这些技术相关的最常见并发症是术后出血和穿孔。本研究的目的是评估 CER 对千分之 20 mm 结直肠肿瘤的结果，并阐明并发症的预测因素。我们在 18 个专业机构进行了一项多中心前瞻性研究。从2007年10月到2010年12月，参与机构进行了1,029次CER。我们前瞻性地收集数据并分析性别、年龄、肿瘤大小、大体外观、切除方式等。切除的息肉平均大小为26.4+/-8.6mm（范围20-120mm）。最终病理结果为维也纳分类 1 类或 2 类（24 例）、3 类（502 例）、4 类或 5 类（503 例）。术后出血和术中穿孔分别为 16 例（1.6%）和 8 例（0.78%）。总体并发症发生率为2.3%。多变量分析中出血的危险因素仅是60岁以下的患者。多变量分析中穿孔的危险因素是整块切除和维也纳分类4-5类。性别、大小、肿瘤部位、大体外观、治疗方法、吹入方式等方面并发症发生率差异无统计学意义。CER是治疗大结直肠病灶安全、高效、有效的微创治疗方法。然而，60 岁以下患者应注意术后出血，维也纳分类 4-5 类病例或尝试整块切除时应注意穿孔。
Conventional endoscopic resection (CER) includes polypectomy and endoscopic mucosal resection. The most common complications related to these techniques are post procedure bleeding and perforation. The aim of this study was to evaluate the outcomes of CER for colorectal neoplasms a parts per thousand 20 mm and to clarify predictive factors for complications.We conducted a multicenter prospective study at 18 specialized institutes. From October 2007 to December 2010, 1,029 CERs were performed at participating institutes. We collected the data prospectively and analyzed gender, age, tumor size, gross appearance, mode of resection, etc.The mean size of polyps resected was 26.4 +/- A 8.6 mm (range 20-120 mm). The final pathology was Vienna classification category 1 or 2 in 24, category 3 in 502, and category 4 or 5 in 503 lesions. Post procedure bleeding and intra procedure perforation occurred, respectively, in 16 (1.6 %) and 8 cases (0.78 %). The overall complication rate was 2.3 %. Risk factors for bleeding in multivariate analysis were only patients under 60 years of age. Risk factors for perforation in multivariate analysis were en bloc resection and Vienna classification category 4-5. The difference of complication rate was not statistically significant regarding gender, size, tumor location, gross appearance, treatment method, and kind of insufflation.CER is a safe, efficient, and effective minimally invasive therapy for large colorectal lesions. However, care should be taken for post procedure bleeding in patients under 60 years of age and for perforation in cases of Vienna classification category 4-5 or when an en bloc resection is tried.