Treatment with argon plasma coagulation reduces recurrence after piecemeal resection of large sessile colonic polyps: a randomized trial and recommendations
Treatment with argon plasma coagulation reduces recurrence after piecemeal resection of large sessile colonic polyps: a randomized trial and recommendations
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DOI：
10.1067/mge.2002.121597
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发表时间：
2002-03-01
影响因子：
7.7
通讯作者：
Williams, CB
中科院分区：
文献类型：
--
作者：
Brooker, JC;Saunders, BP;Williams, CB
背景：大无蒂结直肠息肉分段圈套切除术后复发很常见。本研究的目的是评估在表面完全分片切除后，将氩气等离子凝固（APC）应用于息肉切除部位的边缘和基底部，以预防复发的安全性和有效性。方法：采用分片勒除器烧灼切除的大（>1.5 cm）无蒂息肉患者被分为两组。第一个是内窥镜医师认为息肉已被完全切除的患者。这些患者被随机分组，要么不进行进一步治疗（对照），要么接受边缘 APC 以及息肉切除部位底部的任何残留粘膜或粘膜下组织。第二组包括经内窥镜医师判断息肉未通过圈套器息肉切除术完全切除的患者； APC 常规应用于所有可见的剩余腺瘤组织，无需随机化。 3个月和1年内进行随访结肠镜检查；常规从切除部位采集活检标本，并按照指示进一步进行息肉切除术。结果：随机组中 APC 后复发较少（1/10 APC，7/11 无 APC；p = 0.02）。在最初进行不完全圈套器息肉切除术的组中，尽管进行了 APC，但 13 例中有 6 例在 3 个月时检测到复发。一名患者因腹痛和轻微直肠出血而住院，但不需要干预。没有出现由分段息肉切除术引起的其他严重晚期出血事件。一名患者因内镜治疗失败而被转诊接受手术。结论：对于明显完全内镜圈套器切除大腺瘤的患者，息肉切除术后应用 APC 可减少腺瘤复发。
Background: Recurrence is frequent after piecemeal snare resection of large sessile colorectal polyps. The aim of this study was to evaluate the safety and efficacy of argon plasma coagulation (APC) in preventing recurrence when applied to the edge and base of the polypectomy site after apparently complete piecemeal resection.Methods: Patients with large (>1.5 cm) sessile polyps removed by piecemeal snare cautery were placed into 2 groups. The first consisted of patients with polyps believed by the endoscopist to be completely excised. These patients were randomized to either no further therapy (control) or to APC of the rim and any residual mucosal or submucosal tissue in the base of the polypectomy site. The second group comprised patients in whom polyps, as judged by the endoscopist, were incompletely excised by snare polypectomy; APC was routinely applied without randomization to all visible remaining adenomatous tissue. Follow-up colonoscopy was performed within 3 months and 1 year; biopsy specimens were taken routinely from the resection site and further polypectomy was performed as indicated.Results: There were fewer recurrences after APC in the randomized group (1/10 APC, 7/11 no APC; p = 0.02). In the group with initial incomplete snare polypectomy, recurrence was detected at 3 months in 6 of 13 despite APC. One patient was hospitalized with abdominal pain and minor rectal bleeding but required no intervention. There were no other episodes of significant late bleeding caused by piecemeal polypectomy. One patient was referred for surgery after unsuccessful endoscopic management.Conclusions: In patients with apparent complete endoscopic snare resection of large adenomas, postpolypectomy application of APC reduces adenomatous recurrence.