冷内镜黏膜切除术比较常规内镜黏膜切除术治疗5-10mm结直肠无蒂腺瘤的疗效分析

Efficacy of cold endoscopic mucosal resection vs conventional endoscopic mucosal resection in treatment of nonpedunculated colorectal polyps sized 5-10mm

背景冷圈套器息肉切除术(cold snare polypectomy,CSP)已逐步应用于结直肠小息肉(6-9 mm)的治疗.冷内镜黏膜切除术(endoscopic mucosal resection,EMR)是在CSP技术基础上结合了黏膜下注射水垫,有研究报道冷EMR切除6-9 mm结直肠腺瘤的组织学完全切除率明显优于CSP.然而,冷EMR与常规EMR比较其疗效如何,目前与之相关的研究尚少.目的比较冷EMR与常规EMR治疗5-10 mm结直肠无蒂腺瘤的疗效与安全性.方法2019-08/2020-12间,至我院消化内镜中心行结直肠息肉切除的连续住院患者,符合纳入标准的息肉,按照随机数字表以(1:1)进行随机分配冷EMR或常规EMR进行切除,对息肉组织学完全切除率、切除术中即刻出血以及术后延迟出血进行观察.结果纳入181例患者共计195个息肉,其中冷EMR组90例患者98个息肉、常规EMR组91例患者97个息肉.全组息肉整块切除率为98.5%,无1例穿孔;冷EMR组与常规EMR组的组织学完全切除率分别为91.8%和95.9%(差异4.1%:95%CI-3.9-12.3);按息肉大小进行亚组分析:5-7 mm、8-10 mm息肉冷EMR与常规EMR的组织学完全切除率分别为94.6%与100%(差异5.4%;95%CI:-8.3-19.5)、90.2%与93.8%(差异3.6%;95%CI:-7.8-15.4);冷EMR与常规EMR组术中即刻出血率分别为2.0%和1.0%,术后延迟出血率分别为0%和1%,差异均无统计学意义.结论冷EMR是5-10 mm结直肠无蒂腺瘤安全有效的治疗措施,其组织学完全切除率并不劣于常规EMR,值得临床选择使用.

BACKGROUND Cold snare polypectomy(CSP)has been gradually applied to remove small colorectal polyps(6-9 mm).Cold endoscopic mucosal resection(EMR)is based on CSP technology combined with submucosal injection of water.Studies have reported that the histological complete resection rate of cold EMR of 6-9 mm colorectal adenoma is significantly better than that of CSP.However,there are few studies on the efficacy of cold EMR vs conventional EMR.AIM To compare the efficacy and safety of cold EMR and conventional EMR for 5-10 mm colorectal adenomas.METHODS From August 2019 to December 2020,consecutive hospitalized patients who underwent colorectal polypectomy at the Digestive Endoscopy Center of our hospital were screened for eligible polyps.Eligible polyps were randomized to be treated with either cold EMR or conventional EMR according to a random number table(1:1).The histological complete resection rate,immediate postpolypectomy bleeding,and delayed postpolypectomy bleeding were analyzed.RESULTS One hundred and eighty-one patients with 195 eligible polyps were included,including 90 patients with 98 polyps in the cold EMR group and 91 patients with 97 polyps in the conventional EMR group.The en bloc resection rate of polyps in the overall population was 98.5%,and there was no perforation.The overall rate of histological complete resection was 91.8%in the cold EMR group and 95.9%in the EMR group(difference:4.1%;95%CI:-3.9-12.3).Subgroup analysis by polyp size showed that the histological complete resection rates were 94.6%and 100%for 5-7 mm polyps(difference:5.4%;95%CI:-8.3-19.5),and 90.2%and 93.8%for 8-10 mm polyps(difference:3.6%;95%CI:-7.8-15.4).The immediate postpolypectomy bleeding rates of the cold EMR and conventional EMR groups were 2.0%and 1.0%,and the delayed postpolypectomy bleeding rates were 0%and 1%,respectively;there was no statistically significant difference between the two groups.CONCLUSION Cold EMR is a safe and effective treatment for 5-10 mm colorectal adenoma,with a histological complete resection rate not inferior to that of conventional endoscopic mucosal resection.