Endoscopic mucosal resection with circumferential incision for the treatment of large sessile polyps and laterally spreading tumors of the colorectum.
Endoscopic mucosal resection with circumferential incision for the treatment of large sessile polyps and laterally spreading tumors of the colorectum.
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DOI：
10.5946/ce.2015.48.1.52
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发表时间：
2015-01
影响因子：
2.5
通讯作者：
Kang DH
中科院分区：
文献类型：
--
作者：
Hong YM;Kim HW;Park SB;Choi CW;Kang DH
内镜下黏膜切除术（EMR）是结直肠息肉（如腺瘤和早期癌症）的标准治疗方法，无淋巴结转移风险。然而，内镜下切除大的结直肠息肉（直径≥20 mm）是困难的。我们评价了环形切口EMR（EMR-CI）切除结直肠大无蒂息肉（Is）和侧向扩散型肿瘤（LST）的临床结果。2009年2月至2011年3月，我们通过EMR-CI切除了80例大肠大息肉。我们回顾性研究了整块切除率、组织学完全切除率、复发率和并发症。息肉的平均大小约为25 mm（范围，20 - 50），形态类型包括Is（13例），LST颗粒（37例）和LST非颗粒（30例）。组织学完整切除率和完全切除率分别为66.3%和45.0%。复发率为0%（中位随访时间为23个月），5例（6.3%）发生穿孔。EMR-CI是20至30 mm大小的结直肠息肉的有效治疗方式，如果ESD困难，可以考虑作为二线治疗选择。
Endoscopic mucosal resection (EMR) is the standard treatment for colorectal polyps such as adenomas and early cancers with no risk of lymph node metastasis. However, endoscopic resection of large colorectal polyps (≥20 mm diameter) is difficult to perform. We evaluated the clinical outcomes of EMR with circumferential incision (EMR-CI) for the resection of large sessile polyps (Is) and laterally spreading tumors (LSTs) in the colorectum. Between February 2009 and March 2011, we resected 80 large colorectal polyps by EMR-CI. We retrospectively investigated the en bloc resection rate, histologic complete resection rate, recurrence rate, and complications. The median polyp size was approximately 25 mm (range, 20 to 50), and the morphologic types included Is (13 cases), LST-granular (37 cases), and LST-nongranular (30 cases). The en bloc and complete histologic resection rates were 66.3% and 45.0%, respectively. The recurrence rate was 0% (median follow-up duration, 23 months), and perforation occurred in five cases (6.3%). EMR-CI is an effective treatment modality for 20 to 30 mm-sized colorectal polyps, and may be considered as a second line therapeutic option if ESD is difficult.