A blinded comparison of the safety and efficacy of hot biopsy forceps electrocauterization and conventional snare polypectomy for diminutive colonic polypectomy in a porcine model
A blinded comparison of the safety and efficacy of hot biopsy forceps electrocauterization and conventional snare polypectomy for diminutive colonic polypectomy in a porcine model
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DOI：
10.1016/j.gie.2012.09.014
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发表时间：
2013-03-01
影响因子：
7.7
通讯作者：
Bourke, Michael J.
中科院分区：
文献类型：
--
作者：
Metz, Andrew J.;Moss, Alan;Bourke, Michael J.
背景资料：虽然与穿孔、浆膜炎、延迟出血和不完全切除有关，但热活检钳电烙术（HBF）仍广泛用于小型结肠息肉切除术。目的：评价HBF与传统圈套息肉切除术（CSP）相比的安全性和有效性。设计：随机、盲法、对照试验。设置：学术内窥镜单位。受试者：10只猪。干预：82例成对息肉切除术（41例HBF，41例CSP），均为小的、轻微隆起的人工病变。标准化技术，使用25 W的直流电。HBF：在1 - 2秒的电流导致人工椎弓根变白后，组织被撕脱。CSP：息肉通过圈套透热法去除。主要结果测量：在尸检时切除标本和结肠切除标本中息肉切除部位的组织学（侧面粘膜和溃疡、坏死和炎症的深度）。结果：一些（21%）HBF标本被消融并且无法解释。所有CSP标本均产生了可判读的标本。邻近HBF切除部位的粘液坏死变化很大，在1.5和9 mm之间（平均5.7 mm，标准差+/- 2）。在14%的病例中，HBF溃疡下方有可见的粘膜。两种技术的结肠壁坏死深度有显著差异，HBF组41个病灶中有14个（34%）出现部分固有肌层（MP）坏死，而CSP组41个病灶中有1个（2%）出现MP坏死HBF组中有9例（22%）出现全层MP坏死，而CSP组中有1例（2%）出现全层MP坏死（P = 0.014）。HBF组41处病变中有13处（32%）出现全层MP炎症，CSP组41处病变中有5处（12%）出现全层MP炎症（P = 0.06）。HBF组41个病灶中有13个（32%）观察到硬膜下炎，CSP组41个病灶中有4个（10%）观察到硬膜下炎（P = 0.027）。可见的外侧粘膜损伤和损伤深度之间没有关系（rs = -0.07）。局限性：动物研究。结论：尽管使用标准化HBF技术，但存在广泛的外侧粘膜和深部热损伤以及残留靶粘膜。HBF还导致组织损伤的深度显著更大，具有高比例的透壁坏死。在手术过程中确保粘膜最小程度的漂白并不能防止深度损伤。与传统的圈套器息肉切除术相比，HBF不精确，可能无效且危险。（Gastrointest Endosc 2013;77：484-90.）
Background: Although linked with perforation, serositis, delayed bleeding, and incomplete resection, hot biopsy forceps electrocauterization (HBF) is still widely used for diminutive colonic polypectomy.Objective: To evaluate the safety and efficacy of HBF in comparison with conventional snare polypectomy (CSP).Design: Randomized, blinded, controlled trial.Setting: Academic endoscopy unit.Subjects: Ten swine.Intervention: Eighty-two paired polypectomies (41 HBF, 41 CSP) of small, minimally elevated, artificial lesions. Standardized technique using coagulating current at 25 W. HBF: the tissue was avulsed after 1 to 2 seconds of current caused blanching of the artificial pedicle. CSP: the polyp was removed by snare diathermy.Main Outcome Measurements: Histopathology of resected specimens and polypectomy sites in colectomy specimens at necropsy (lateral mucosal and depth of ulceration, necrosis and inflammation).Results: Some (21%) of the HBF specimens were ablated and uninterpretable. All CSP specimens yielded interpretable specimens. Mucosal necrosis adjacent to HBF resection sites varied widely, between 1.5 and 9 mm (mean 5.7 mm, standard deviation +/- 2). There was visible mucosa under the HBF ulcer in 14% of cases. The depth of necrosis in the colon wall was significantly different between the two techniques, with partial muscularis propria (MP) necrosis in 14 of 41 lesions (34%) with HBF, compared with 1 of 41 (2%) of CSP (P < .001), and full-thickness MP necrosis in 9 of 41 lesions (22%) with HBF, compared with 1 of 41 (2%) of CSP (P = .014). There was full-thickness MP inflammation in 13 of 41 lesions (32%) with HBF compared with 5 of 41 (12%) of CSP (P = .06). Transmural subserosal inflammation was seen in 13 of 41 lesions (32%) with HBF compared with 4 of 41 (10%) of CSP (P = .027). There was no relationship between visible lateral mucosal injury and depth of injury (rs = -0.07).Limitations: Animal study.Conclusion: Despite use of the standardized HBF technique, there is a wide range of lateral mucosal and deep thermal injury as well as residual target mucosa. HBF also results in a significantly greater depth of tissue injury, with a high proportion of transmural necrosis. Ensuring minimal blanching of the mucosa during the procedure does not protect from deep injury. In comparison to conventional snare polypectomy, HBF is imprecise, potentially ineffective, and hazardous. (Gastrointest Endosc 2013;77:484-90.)