Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline
Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline
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DOI：
10.1055/s-0043-102569
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发表时间：
2017-03-01
期刊：
影响因子：
9.3
通讯作者：
Bourke, Michael J.
中科院分区：
文献类型：
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作者：
Ferlitsch, Monika;Moss, Alan;Bourke, Michael J.
1 ESGE推荐冷圈套息肉切除术（CSP）作为切除小型息肉（尺寸≤ 5 mm）的首选技术。 该技术具有较高的完全切除率、组织学检查所需的足够组织取样率和较低的并发症发生率。(High质量证明，强烈推荐。）2 ESGE建议CSP用于6 - 9 mm大小的无蒂息肉，因为其上级安全性，尽管缺乏与热圈套息肉切除术（HSP）比较疗效的证据。 （中等质量证据，弱推荐。）3ESGE建议HSP（伴或不伴粘膜下注射）用于切除大小为10-19 mm的无蒂息肉。 在大多数情况下，深部热损伤是一种潜在的风险，因此应考虑在HSP之前进行粘膜下注射。(Low质量证明，强烈推荐。）4 ESGE建议HSP用于带蒂息肉。为预防头部≥ 20 mm或息肉柄直径≥ 10 mm的带蒂结直肠息肉出血，ESGE建议通过注射稀释的肾上腺素和/或机械止血对息肉柄进行预处理。 （中等质量证据，强烈推荐。）5ESGE建议内镜下粘膜切除术（EMR）的目标是以最安全的最小碎片数量实现完全圈套切除病变，具有足够的边缘，无需连续消融技术。(Low质量证明;强烈推荐。）6 ESGE建议在EMR前仔细评估病变，以识别提示不良结局的特征。与不完全切除或复发相关的特征包括病变大小> 40 mm、回盲瓣位置、既往切除尝试失败以及大小、形态、部位和入路（SMSA）4级。（中等质量证据;强烈推荐。）7对于术中出血，ESGE建议内镜下电凝（圈套器头软凝或止血钳）或机械治疗，联合或不联合使用稀释肾上腺素注射。(Low质量证明，强烈推荐。）根据息肉的形状和大小，给出了息肉切除术的建议算法（图1）。
1ESGE recommends cold snare polypectomy (CSP) as the preferred technique for removal of diminutive polyps (size ≤ 5 mm). This technique has high rates of complete resection, adequate tissue sampling for histology, and low complication rates. (High quality evidence, strong recommendation.)2ESGE suggests CSP for sessile polyps 6 – 9 mm in size because of its superior safety profile, although evidence comparing efficacy with hot snare polypectomy (HSP) is lacking. (Moderate quality evidence, weak recommendation.)3ESGE suggests HSP (with or without submucosal injection) for removal of sessile polyps 10 – 19 mm in size. In most cases deep thermal injury is a potential risk and thus submucosal injection prior to HSP should be considered. (Low quality evidence, strong recommendation.)4ESGE recommends HSP for pedunculated polyps. To prevent bleeding in pedunculated colorectal polyps with head ≥ 20 mm or a stalk ≥ 10 mm in diameter, ESGE recommends pretreatment of the stalk with injection of dilute adrenaline and/or mechanical hemostasis. (Moderate quality evidence, strong recommendation.)5ESGE recommends that the goals of endoscopic mucosal resection (EMR) are to achieve a completely snare-resected lesion in the safest minimum number of pieces, with adequate margins and without need for adjunctive ablative techniques. (Low quality evidence; strong recommendation.)6ESGE recommends careful lesion assessment prior to EMR to identify features suggestive of poor outcome. Features associated with incomplete resection or recurrence include lesion size > 40 mm, ileocecal valve location, prior failed attempts at resection, and size, morphology, site, and access (SMSA) level 4. (Moderate quality evidence; strong recommendation.)7For intraprocedural bleeding, ESGE recommends endoscopic coagulation (snare-tip soft coagulation or coagulating forceps) or mechanical therapy, with or without the combined use of dilute adrenaline injection. (Low quality evidence, strong recommendation.)An algorithm of polypectomy recommendations according to shape and size of polyps is given (Fig. 1).