Endoscopic submucosal dissection of large pedunculated polyps with wide stalks: a retrospective multicenter study
Endoscopic submucosal dissection of large pedunculated polyps with wide stalks: a retrospective multicenter study
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DOI：
10.1055/a-1194-4413
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发表时间：
2021-01-01
期刊：
影响因子：
9.3
通讯作者：
Nakajima, Atsushi
中科院分区：
文献类型：
--
作者：
Chiba, Hideyuki;Tachikawa, Jun;Nakajima, Atsushi
背景内镜下切除大的带蒂结直肠息肉在技术上是困难的，特别是当息肉很大并且有很厚的蒂时，传统的圈套器很难或不可能切除。方法对29例不能通过息肉切除术或内镜下黏膜切除术切除的大息肉患者进行内镜下息肉切除术，观察内镜下息肉切除术治疗大息肉的可行性。1例暂停病例是由于严重纤维化伴肌肉收缩体征。29个息肉头的平均直径为39.7（标准差6.9）mm。16个息肉（9个轻度; 7个重度）中存在粘膜下纤维化。重度纤维化息肉的息肉柄明显厚于无纤维化或轻度纤维化息肉。结论ESD是治疗传统圈套器切除困难或不可能切除的大蒂息肉的一种有效方法。
Background Endoscopic resection of large pedunculated colorectal polyps is technically difficult, especially when the polyp is large and has such a thick stalk that it is either too difficult or impossible to resect prophylactically by a conventional snare. Here, we evaluated the feasibility of ESD for large pedunculated polyps with wide stalks.Methods 29 patients with large pcdunculated polyps that were not resectable by polypectomy or endoscopic mucosal resection were enrolled in the study.Results En bloc resection was achieved in 28/29 polyps. One suspended case was due to severe fibrosis with muscle retraction signs. The mean diameter of the 29 polyp heads was 39.7 (standard deviation 6.9) mm. Submucosal fibrosis was present in 16 polyps (9 mild; 7 severe). The stalks of severely fibrotic polyps were significantly thicker than those of polyps with no or mild fibrosis. The curative resection rate was 85.7% without severe complications.Conclusions ESD is feasible for the removal of large pedunculated polyps with wide stalks when conventional snare resection is difficult or impossible.