冷热圈套器内镜下黏膜切除术对结直肠息肉疗效及安全性比较

Comparison on the efficacy and safety of endoscopic mucosal resection with cold or hot snare for colorectal polyps

目的探讨冷圈套内镜下黏膜切除术(CS-EMR)与热圈套内镜下黏膜切除术(HS-EMR)对直径6~14 mm结直肠息肉治疗的效果及安全性比较。方法前瞻性选取2017年10月至2018年12在解放军联勤保障部队第九〇〇医院消化内科行肠镜检查发现患有6~14 mm结直肠息肉并满足纳入标准的患者400例,按1∶1随机分配接受HS-EMR或CS-EMR,两组拟切除息肉在治疗前均先黏膜下注射亚甲基美兰生理盐水抬举病灶,接着,HS-EMR组采用热圈套器切除抬举息肉,而CS-EMR组则采用冷圈套器切除。主要结局指标:在窄带成像技术(NBI)下对息肉切除部位的底侧切缘予以活检评估组织学完整切除率,次要结局指标:息肉切除时间、回收情况、术中出血穿孔、术后迟发性出血穿孔等。结果HS-EMR组(n=200)和CS-EMR组(n=200)病灶平均大小分别为(10.1±1.87)mm和(9.87±2.13)mm。患者的性别、年龄、肠镜指征等一般情况及息肉部位、大小、形态、分型在组间均衡。CS-EMR组对6~14 mm息肉的组织学完整切除率为93.0%(186/200)与HS-EMR组94.5%(189/200)相似,差异无统计学意义(P>0.05),但CS-EMR对6~9 mm息肉的组织学完整切除率高达96.1%,优于10~14 mm息肉89.8%。HS-EMR组出现5例迟发性出血和2例迟发性穿孔,但CS-EMR组均未出现迟发性出血、穿孔。结论CS-EMR在6~14 mm结直肠息肉治疗中安全、有效,尤其对于6~9 mm息肉有与HS-EMR相媲美的组织学高完整切除率,又保留单纯CS-EMR的低迟发性并发症风险,有望成为继CS-EMR后一种更有价值的新型冷切技术。

Objective To investigate the efficacy and safety of cold snare endoscopic mucosal resection(CS-EMR)and hot snare endoscopic mucosal resection(HS-EMR)for colorectal polyps with diameters of 6-14 mm.Methods 400 patients with colorectal polyps(diameter 6-14 mm)found by colonoscopy was prospectively and randomly selected in the Department of Gastroenterology,the 900th Hospital of Joint Logistics Support Force from Oct.2017 to Dec.2018,candidates were randomized(1∶1)to be treated with either CS-EMR or HS-EMR.Before treatment,the lesions were lifted by submucosal injection of methylene blue saline.Then,the HS-EMR group used hot snare to remove the lifting polyps,while the CS-EMR group used cold snare to remove the lifting polyps.Main outcome measures:biopsy was performed at the base and margins of polypectomy sites under narrow band imaging(NBI)to evaluate the histological complete resection rate.Secondary outcomes included the resection time of polyps,retrieval.Procedure-related adverse events.Results The average size of lesions in HS-EMR group(n=200)and CS-EMR group(n=200)were(10.1±1.87)mm and(9.87±2.13)mm,respectively.Gender,age,colonoscopic indications and the location,size,type and classification of polyps were balanced among groups.The complete resection rate of 6-14 mm polyps in CS-EMR group was 93.0%(186/200)similar to 94.5%(189/200)in HS-EMR group(P>0.05),but the complete resection rate of 6-9 mm polyps in CS-EMR group was 96.1%,better than that of 10-14 mm polyps.There were 5 cases of delayed bleeding and 2 cases of delayed perforation in HS-EMR group,but there were no delayed bleeding and perforation in CS-EMR group.Conclusion CS-EMR is safe and effective in the treatment of 6-14 mm colorectal polyps.Especially for 6-9 mm polyps,CS-EMR has a high complete resection rate comparable to HS-EMR,and retains the low risk of delayed complications after polypectomy with cold snare.CS-EMR is expected to become a more valuable new cold-cutting technique after cold snare polypectomy.