A proportion of neoplastic polyps are incompletely resected, resulting in local recurrence, especially after resection of large polyps or piecemeal resection. Local recurrences that develop after endoscopic resection ...A proportion of neoplastic polyps are incompletely resected, resulting in local recurrence, especially after resection of large polyps or piecemeal resection. Local recurrences that develop after endoscopic resection of intramucosal neoplasms that lacked risk factors for lymph node metastasis or positive vertical margins are usually treated endoscopically. Endoscopic submucosal dissection(ESD) is indicated for local residual or recurrent early carcinomas after endoscopic resection. However, ESD for such recurrent lesions is technically difficult and is typically a lengthy procedure. Underwater endoscopic mucosal resection(UEMR), which was developed in 2012, is suitable for recurrent or residual lesions and reportedly achieves superior en bloc resection rates and endoscopic complete resection rates than conventional EMR. However, a large recurrent lesion is a negative independent predictor of successful en bloc resection and of complete endoscopic removal. We therefore perform UEMR for relatively small(≤ 10-15 mm) recurrent lesions and ESD for larger lesions.展开更多
Current guidelines recommend cold snare polypectomy for polyps less than 10 mm in size.Conversely,endoscopic mucosal resection is still the preferred technique for larger polyps.Concerns regarding cold snare polypecto...Current guidelines recommend cold snare polypectomy for polyps less than 10 mm in size.Conversely,endoscopic mucosal resection is still the preferred technique for larger polyps.Concerns regarding cold snare polypectomy for larger polyps revolve around the difficulty in conducting en-bloc resection(resulting in piecemeal removal),and the potential for local residual polyp tissue and a high rate of recurrence.On the other hand,cold snare technique has the advantages of shortening procedure time,reducing delayed bleeding risks and lowering cost of treatment.Numerous ongoing and recent studies are focused on evaluating the risks and benefits of this technique for polyps larger than 10 mm,with the goal of providing clear guidelines in the near future.The aim of this editorial is to provide our readers with an overview regarding this subject and the latest developments surrounding it.展开更多
BACKGROUND Endoscopic submucosal dissection(ESD)has shown to be effective in management of colorectal neoplasm in the Asian countries,while its implementation in Western countries where endoscopic mucosal resection(EM...BACKGROUND Endoscopic submucosal dissection(ESD)has shown to be effective in management of colorectal neoplasm in the Asian countries,while its implementation in Western countries where endoscopic mucosal resection(EMR)is preferred is still debatable.AIM To compare the surgical,histological,and oncological outcomes between ESD and EMR in the treatment of colorectal polyps,with subgroup analysis comparing the efficacy of ESD and EMR between Japan and the rest of the world.METHODS Embase and Medline databases were searched from inception to October 2020 in accordance with PRISMA guidelines for studies comparing en bloc,complete resection,margin involvement,resection time,need for additional surgery,complications,and recurrence rate of ESD with EMR.RESULTS Of 281344 colorectal polyps from 21 studies were included.When compared to EMR,the pooled analysis revealed ESD was associated with higher en bloc and complete resection rate,and lower lateral margin involvement and recurrence.ESD led to increased procedural time,need for additional surgery,and perforation risk.No significant difference in bleeding risk was found between the two groups.Meta-regression analysis suggested only right colonic polyps correlated with an increased perforation risk in ESD.Confounders including polyp size and invasion depth did not significantly influence the en bloc and complete resection rate,bleeding risk and recurrence.In subgroup analysis,Japan performed better than the rest of the world in both ESD and EMR with perforation risk of 4%and 0.0002%,respectively,as compared to perforation risk of 8%and 1%,respectively,in reports coming from rest of the world.CONCLUSION ESD resulted in better resection outcomes and lower recurrence compared to EMR.With appropriate training,ESD is preferred over EMR as the first-line therapy for resection of colorectal polyps,without restricting to lesions greater than 20 mm and those with high suspicion of submucosal invasion.展开更多
AIM: To investigate whether out-patient based endo-scopic mucosal resection(EMR) for colon polyps ≤ 10 mm is safe.METHODS: Between January 2004 and December 2012, a total of 3015 EMR cases conducted in 1320 patients ...AIM: To investigate whether out-patient based endo-scopic mucosal resection(EMR) for colon polyps ≤ 10 mm is safe.METHODS: Between January 2004 and December 2012, a total of 3015 EMR cases conducted in 1320 patients were retrospectively reviewed. The factors contributing delayed hemorrhage were analyzed. We calculated the probability of delayed bleeding after stratifying conditions of specific risk factors.RESULTS: The size of the polyp(95%CI: 1.096-1.164, P < 0.001) and patients with chronic renal failure(95%CI: 1.856-45.106, P = 0.007) were identified as independent risk factors for delayed bleeding in multi-variate analysis. 95%CI for percent of delayed bleedingaccording to polyp size was determined for the fol-lowing conditions: size ≤ 10 mm, 0.05%-0.43%; 20 mm ≥ size > 10 mm, 0.54%-2.08%; size > 20 mm, 4.22%-11.41%. 95%CI was determined for the risk of serious immediate bleeding for a polyp ≤ 10 mm was 0.10%-0.56%. Finally, 95%CI for percent of incomplete resection was 0.07%-0.49% in polyps ≤ 10 mm. CONCLUSION: It seems acceptable to perform outpa-tient-based EMR for colon polyps ≤ 10 mm.展开更多
BACKGROUND Solitary hamartomatous polyps(SHPs)are rare lesions.Endoscopic full-thickness resection(EFTR)is a highly efficient and minimally invasive endoscopic procedure that benefits from complete lesion removal and ...BACKGROUND Solitary hamartomatous polyps(SHPs)are rare lesions.Endoscopic full-thickness resection(EFTR)is a highly efficient and minimally invasive endoscopic procedure that benefits from complete lesion removal and high safety.CASE SUMMARY A 47-year-old man was admitted to our hospital after experiencing hypogastric pain and constipation for over fifteen days.Computed tomography and endoscopy revealed a giant pedunculated polyp(approximately 18 cm long)in the descending and sigmoid colon.This is the largest SHP reported to date.Having considered the condition of the patient and mass growth,the polyp was removed using EFTR.CONCLUSION On the basis of clinical and pathological evaluations,the mass was considered an SHP.展开更多
Colorectal cancer(CRC)is the third most common cancer worldwide and the second leading cause of cancer related death in the world.The early detection and removal of CRC precursor lesions has been shown to reduce the i...Colorectal cancer(CRC)is the third most common cancer worldwide and the second leading cause of cancer related death in the world.The early detection and removal of CRC precursor lesions has been shown to reduce the incidence of CRC and cancer-related mortality.Endoscopic resection has become the first-line treatment for the removal of most precursor benign colorectal lesions and selected malignant polyps.Detailed lesion assessment is the first critical step in the evaluation and management of colorectal polyps.Polyp size,location and both macro-and micro-features provide important information regarding histological grade and endoscopic resectability.Benign polyps and even malignant polyps with superficial submucosal invasion and favorable histological features can be adequately removed endoscopically.When compared to surgery,endoscopic resection is associated with lower morbidity,mortality,and higher patient quality of life.Conversely,malignant polyps with deep submucosal invasion and/or high risk for lymph node metastasis will require surgery.From a practical standpoint,the most appropriate strategy for each patient will need to be individualized,based not only on polyp-and patient-related characteristics,but also on local resources and expertise availability.In this review,we provide a broad overview and present a potential decision tree algorithm for the evaluation and management of colorectal polyps that can be widely adopted into clinical practice.展开更多
Traditional serrated adenoma(TSA)is a type of serrated polyp of the colorectum and is thought to be a precancerous lesion.There are three types of serrated polyps,namely,hyperplastic polyps,sessile serrated adenomas/p...Traditional serrated adenoma(TSA)is a type of serrated polyp of the colorectum and is thought to be a precancerous lesion.There are three types of serrated polyps,namely,hyperplastic polyps,sessile serrated adenomas/polyps,and TSAs.TSA is the least common of the three types and accounts for about 5% of serrated polyps.Here we report a pediatric case of TSA that was successfully resected by endoscopic submucosal dissection(ESD).This rare case report describes a pediatric patient with no family history of colonic polyp who was admitted to our hospital with hematochezia.On colonoscopy,we found a polypoid lesion measuring 10 mm in diameter in the lower rectum.We selected ESD as a surgical option for en bloc resection,and histopathological examination revealed TSA.The findings in this case suggest that TSA with precancerous potential can occur in children,and that ESD is useful for treating this lesion.展开更多
Colon cancer remains a significant clinical problem worldwide and in the United States it is the third most common cancer diagnosed in men and women.It is generally accepted that most malignant neoplasms of the colon ...Colon cancer remains a significant clinical problem worldwide and in the United States it is the third most common cancer diagnosed in men and women.It is generally accepted that most malignant neoplasms of the colon arise from precursor adenomatous polyps.This stepwise progression of normal epithelium to carcinoma,often with intervening dysplasia,occurs as a result of multiple sequential,genetic mutations-some are inherited while others are acquired.Malignant polyps are defined by the presence of cancer cells invading through the muscularis mucosa into the underlying submucosa(T1).They can appear benign endoscopically but the presence of malignant invasion histologically poses a difficult and often controversial clinical scenario.Emphasis should be initially focused on the endoscopic assessment of these lesions.Suitable polyps should be resected en-bloc,if possible,to facilitate thorough evaluation by pathology.In these cases,proper attention must be given to the risks of residual cancer in the bowel wall or in the surrounding lymph nodes.If resection is not feasible endoscopically,thenthese patients should be referred for surgical resection.This review will discuss the important prognostic features of malignant polyps that will most profoundly affect this risk profile.Additionally,we will discuss effective strategies for their overall management.展开更多
AIM: To compare previously reported randomized controlled studies (RCTs) of cold and hot polypectomy, we systematically reviewed and clarify the utility of cold polypectomy over hot with respect to efficacy and advers...AIM: To compare previously reported randomized controlled studies (RCTs) of cold and hot polypectomy, we systematically reviewed and clarify the utility of cold polypectomy over hot with respect to efficacy and adverse events.METHODS: A meta-analysis was conducted to evaluate the predominance of cold and hot polypectomy for removing colon polyps. Published articles and abstracts from worldwide conferences were searched using the keywords “cold polypectomy”. RCTs that compared either or both the effects or adverse events of cold polypectomy with those of hot polypectomy were collected. The patients’ demographics, endoscopic procedures, No. of examined lesions, lesion size, macroscopic and histologic findings, rates of incomplete resection, bleeding amount, perforation, and length of procedure were extracted from each study. A forest plot analysis was used to verify the relative strength of the effects and adverse events of each procedure. A funnel plot was generated to assess the possibility of publication bias.RESULTS: Ultimately, six RCTs were selected. No significant differences were noted in the average lesion size (less than 10 mm) between the cold and hot polypectomy groups in each study. Further, the rates of complete resection and adverse events, including delayed bleeding, did not differ markedly between cold and hot polypectomy. The average procedural time in the cold polypectomy group was significantly shorter than in the hot polypectomy group.CONCLUSION: Cold polypectomy is a time-saving procedure for removing small polyps with markedly similar curability and safety to hot polypectomy.展开更多
AIM: To evaluate if traction-assisted endoscopic mucosal resection (TA-EMR) is feasible and if it enables en bloc resection of colorectal lesions. METHODS: Seven patients with a total of 12 colorectal adenomas were pr...AIM: To evaluate if traction-assisted endoscopic mucosal resection (TA-EMR) is feasible and if it enables en bloc resection of colorectal lesions. METHODS: Seven patients with a total of 12 colorectal adenomas were prospectively enrolled. All lesions were removed by TA-EMR: one hemostatic clip tied to a white silk suture was applied to the base of the lesion to allow traction through the working channel of the colonoscope. A conventional polypectomy snare was mounted over the suture and the lesion was pulled into the snare and resected in one piece. RESULTS: All 12 lesions (nine sessile) were resected en bloc with free lateral and vertical margins by using this novel technique, including five lesions (5/12, 41.6%) in less-accessible positions, where TA-EMR enabled complete visualization of the base before resection. Mean longest lesion and specimen sizes were 9 mm (range: 6-25 mm) and 11 mm in diameter (range: 7-17 mm),respectively. No serious procedure-related complications were observed. CONCLUSION: TA-EMR through the endoscope using a hemostatic clip and suture material is technically feasible. Visualization of colorectal lesions in less-accessible locations can be improved.展开更多
AIM: To compare the outcomes of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) of colorectal lesions.METHODS: An electronic systematic literature search of four computerized databa...AIM: To compare the outcomes of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) of colorectal lesions.METHODS: An electronic systematic literature search of four computerized databases was performed in July 2014 identifying studies reporting the outcomes of colorectal ESD and EMR. The primary outcome measures were en-bloc resection rate, endoscopic clearance rate and lesion recurrence rate of the patients followed up. The secondary outcome was the complication rate (including bleeding, perforation and surgery post EMR or ESD rate). Statistical pooling and random effects modelling of the studies calculating risk difference, heterogeneity and assessment of bias and quality were performed.RESULTS: Six observational studies reporting the outcomes of 1324 procedures were included. The en-bloc resection rate was 50% higher in the ESD group than in the EMR group (95%CI: 0.17-0.83, P 〈 0.0001, I2 = 99.7%). Endoscopic clearance rates were also signifcantly higher in the ESD group (95%CI: -0.06-0.02, P 〈 0.0001, I2 = 92.5%). The perforation rate was 7% higher in the ESD group than the EMR group (95%CI: 0.05-0.09, P 〉 0.05, I2 = 41.1%) and the rate of recurrence was 50% higher in the EMR group than in the ESD group (95%CI: 0.20-0.79, P 〈 0.001, I2 = 99.5%). Heterogeneity remained consistent when subgroup analysis of high quality studies was performed (with the exception of piecemeal resection rate), and overall effect sizes remained unchanged for all outcomes.CONCLUSION: ESD demonstrates higher en-bloc resection rates and lower recurrence rates compared to colorectal EMR. Differences in outcomes may beneft from increased assessment through well-designed comparative studies.展开更多
Aim: To study the characteristics of EMR (endoscopic mucosal resection) or ESD (endoscopic submucosal dissection) postoperative pathological examination of colonic polyps in different age groups, and the difference of...Aim: To study the characteristics of EMR (endoscopic mucosal resection) or ESD (endoscopic submucosal dissection) postoperative pathological examination of colonic polyps in different age groups, and the difference of pathological examination after EMR or ESD operation. Methods: A retrospective analysis was made of the EMR or ESD postoperative pathological data of 100 cases of colonic polyps patients in the Jingzhou Central Hospital digestive internal medicine. The time is from March 2016 to March 2018. Results: In 100 cases of EMR or ESD operation, there are 65 cases of young and middle-aged group. Pathological examination results include: 34 cases of adenomatous polyp, 18 cases of inflammatory polyp, 11 cases of benign tumors, 1 case of malignant tumor, 1 case of hyperplastic polyp. There are 35 cases of elderly group. Pathological examination results include: 27 cases of adenomatous polyp, 2 cases of inflammatory polyp, 2 cases of benign tumors, 4 cases of malignant tumor. 71 cases of complete EMR operation include: 51 cases of adenomatous polyp, 17 cases of inflammatory polyp, 3 cases of benign tumors;29 cases of complete ESD operation include: 10 cases of adenomatous polyp, 3 cases of inflammatory polyp, 10 cases of benign tumors, 5 cases of malignant tumor, 1 case of hyperplastic polyp. Conclusion: For the pathological examination results after EMR or ESD operation, the proportion of inflammatory polyps in the young and middle-aged group was greater than that in the elderly group. The proportion of adenomatous polyps in the elderly group was larger than that in the young and middle-aged group. The proportion of adenomatous polyps in EMR was greater than that of ESD. The proportion of benign tumors and malignant tumors in ESD was greater than that of EMR. The difference has statistical significance.展开更多
文摘A proportion of neoplastic polyps are incompletely resected, resulting in local recurrence, especially after resection of large polyps or piecemeal resection. Local recurrences that develop after endoscopic resection of intramucosal neoplasms that lacked risk factors for lymph node metastasis or positive vertical margins are usually treated endoscopically. Endoscopic submucosal dissection(ESD) is indicated for local residual or recurrent early carcinomas after endoscopic resection. However, ESD for such recurrent lesions is technically difficult and is typically a lengthy procedure. Underwater endoscopic mucosal resection(UEMR), which was developed in 2012, is suitable for recurrent or residual lesions and reportedly achieves superior en bloc resection rates and endoscopic complete resection rates than conventional EMR. However, a large recurrent lesion is a negative independent predictor of successful en bloc resection and of complete endoscopic removal. We therefore perform UEMR for relatively small(≤ 10-15 mm) recurrent lesions and ESD for larger lesions.
文摘Current guidelines recommend cold snare polypectomy for polyps less than 10 mm in size.Conversely,endoscopic mucosal resection is still the preferred technique for larger polyps.Concerns regarding cold snare polypectomy for larger polyps revolve around the difficulty in conducting en-bloc resection(resulting in piecemeal removal),and the potential for local residual polyp tissue and a high rate of recurrence.On the other hand,cold snare technique has the advantages of shortening procedure time,reducing delayed bleeding risks and lowering cost of treatment.Numerous ongoing and recent studies are focused on evaluating the risks and benefits of this technique for polyps larger than 10 mm,with the goal of providing clear guidelines in the near future.The aim of this editorial is to provide our readers with an overview regarding this subject and the latest developments surrounding it.
文摘BACKGROUND Endoscopic submucosal dissection(ESD)has shown to be effective in management of colorectal neoplasm in the Asian countries,while its implementation in Western countries where endoscopic mucosal resection(EMR)is preferred is still debatable.AIM To compare the surgical,histological,and oncological outcomes between ESD and EMR in the treatment of colorectal polyps,with subgroup analysis comparing the efficacy of ESD and EMR between Japan and the rest of the world.METHODS Embase and Medline databases were searched from inception to October 2020 in accordance with PRISMA guidelines for studies comparing en bloc,complete resection,margin involvement,resection time,need for additional surgery,complications,and recurrence rate of ESD with EMR.RESULTS Of 281344 colorectal polyps from 21 studies were included.When compared to EMR,the pooled analysis revealed ESD was associated with higher en bloc and complete resection rate,and lower lateral margin involvement and recurrence.ESD led to increased procedural time,need for additional surgery,and perforation risk.No significant difference in bleeding risk was found between the two groups.Meta-regression analysis suggested only right colonic polyps correlated with an increased perforation risk in ESD.Confounders including polyp size and invasion depth did not significantly influence the en bloc and complete resection rate,bleeding risk and recurrence.In subgroup analysis,Japan performed better than the rest of the world in both ESD and EMR with perforation risk of 4%and 0.0002%,respectively,as compared to perforation risk of 8%and 1%,respectively,in reports coming from rest of the world.CONCLUSION ESD resulted in better resection outcomes and lower recurrence compared to EMR.With appropriate training,ESD is preferred over EMR as the first-line therapy for resection of colorectal polyps,without restricting to lesions greater than 20 mm and those with high suspicion of submucosal invasion.
基金Supported by Basic Science Research Program through the National Research Foundation of Korea(NRF) funded by the Ministry of Science,ICT and Future Planning,No.NRF-2013R1A1A1009682
文摘AIM: To investigate whether out-patient based endo-scopic mucosal resection(EMR) for colon polyps ≤ 10 mm is safe.METHODS: Between January 2004 and December 2012, a total of 3015 EMR cases conducted in 1320 patients were retrospectively reviewed. The factors contributing delayed hemorrhage were analyzed. We calculated the probability of delayed bleeding after stratifying conditions of specific risk factors.RESULTS: The size of the polyp(95%CI: 1.096-1.164, P < 0.001) and patients with chronic renal failure(95%CI: 1.856-45.106, P = 0.007) were identified as independent risk factors for delayed bleeding in multi-variate analysis. 95%CI for percent of delayed bleedingaccording to polyp size was determined for the fol-lowing conditions: size ≤ 10 mm, 0.05%-0.43%; 20 mm ≥ size > 10 mm, 0.54%-2.08%; size > 20 mm, 4.22%-11.41%. 95%CI was determined for the risk of serious immediate bleeding for a polyp ≤ 10 mm was 0.10%-0.56%. Finally, 95%CI for percent of incomplete resection was 0.07%-0.49% in polyps ≤ 10 mm. CONCLUSION: It seems acceptable to perform outpa-tient-based EMR for colon polyps ≤ 10 mm.
基金Supported by the Natural Science Foundation of Zhejiang Province,China,No.LY21H290004.
文摘BACKGROUND Solitary hamartomatous polyps(SHPs)are rare lesions.Endoscopic full-thickness resection(EFTR)is a highly efficient and minimally invasive endoscopic procedure that benefits from complete lesion removal and high safety.CASE SUMMARY A 47-year-old man was admitted to our hospital after experiencing hypogastric pain and constipation for over fifteen days.Computed tomography and endoscopy revealed a giant pedunculated polyp(approximately 18 cm long)in the descending and sigmoid colon.This is the largest SHP reported to date.Having considered the condition of the patient and mass growth,the polyp was removed using EFTR.CONCLUSION On the basis of clinical and pathological evaluations,the mass was considered an SHP.
文摘Colorectal cancer(CRC)is the third most common cancer worldwide and the second leading cause of cancer related death in the world.The early detection and removal of CRC precursor lesions has been shown to reduce the incidence of CRC and cancer-related mortality.Endoscopic resection has become the first-line treatment for the removal of most precursor benign colorectal lesions and selected malignant polyps.Detailed lesion assessment is the first critical step in the evaluation and management of colorectal polyps.Polyp size,location and both macro-and micro-features provide important information regarding histological grade and endoscopic resectability.Benign polyps and even malignant polyps with superficial submucosal invasion and favorable histological features can be adequately removed endoscopically.When compared to surgery,endoscopic resection is associated with lower morbidity,mortality,and higher patient quality of life.Conversely,malignant polyps with deep submucosal invasion and/or high risk for lymph node metastasis will require surgery.From a practical standpoint,the most appropriate strategy for each patient will need to be individualized,based not only on polyp-and patient-related characteristics,but also on local resources and expertise availability.In this review,we provide a broad overview and present a potential decision tree algorithm for the evaluation and management of colorectal polyps that can be widely adopted into clinical practice.
文摘Traditional serrated adenoma(TSA)is a type of serrated polyp of the colorectum and is thought to be a precancerous lesion.There are three types of serrated polyps,namely,hyperplastic polyps,sessile serrated adenomas/polyps,and TSAs.TSA is the least common of the three types and accounts for about 5% of serrated polyps.Here we report a pediatric case of TSA that was successfully resected by endoscopic submucosal dissection(ESD).This rare case report describes a pediatric patient with no family history of colonic polyp who was admitted to our hospital with hematochezia.On colonoscopy,we found a polypoid lesion measuring 10 mm in diameter in the lower rectum.We selected ESD as a surgical option for en bloc resection,and histopathological examination revealed TSA.The findings in this case suggest that TSA with precancerous potential can occur in children,and that ESD is useful for treating this lesion.
文摘Colon cancer remains a significant clinical problem worldwide and in the United States it is the third most common cancer diagnosed in men and women.It is generally accepted that most malignant neoplasms of the colon arise from precursor adenomatous polyps.This stepwise progression of normal epithelium to carcinoma,often with intervening dysplasia,occurs as a result of multiple sequential,genetic mutations-some are inherited while others are acquired.Malignant polyps are defined by the presence of cancer cells invading through the muscularis mucosa into the underlying submucosa(T1).They can appear benign endoscopically but the presence of malignant invasion histologically poses a difficult and often controversial clinical scenario.Emphasis should be initially focused on the endoscopic assessment of these lesions.Suitable polyps should be resected en-bloc,if possible,to facilitate thorough evaluation by pathology.In these cases,proper attention must be given to the risks of residual cancer in the bowel wall or in the surrounding lymph nodes.If resection is not feasible endoscopically,thenthese patients should be referred for surgical resection.This review will discuss the important prognostic features of malignant polyps that will most profoundly affect this risk profile.Additionally,we will discuss effective strategies for their overall management.
文摘AIM: To compare previously reported randomized controlled studies (RCTs) of cold and hot polypectomy, we systematically reviewed and clarify the utility of cold polypectomy over hot with respect to efficacy and adverse events.METHODS: A meta-analysis was conducted to evaluate the predominance of cold and hot polypectomy for removing colon polyps. Published articles and abstracts from worldwide conferences were searched using the keywords “cold polypectomy”. RCTs that compared either or both the effects or adverse events of cold polypectomy with those of hot polypectomy were collected. The patients’ demographics, endoscopic procedures, No. of examined lesions, lesion size, macroscopic and histologic findings, rates of incomplete resection, bleeding amount, perforation, and length of procedure were extracted from each study. A forest plot analysis was used to verify the relative strength of the effects and adverse events of each procedure. A funnel plot was generated to assess the possibility of publication bias.RESULTS: Ultimately, six RCTs were selected. No significant differences were noted in the average lesion size (less than 10 mm) between the cold and hot polypectomy groups in each study. Further, the rates of complete resection and adverse events, including delayed bleeding, did not differ markedly between cold and hot polypectomy. The average procedural time in the cold polypectomy group was significantly shorter than in the hot polypectomy group.CONCLUSION: Cold polypectomy is a time-saving procedure for removing small polyps with markedly similar curability and safety to hot polypectomy.
文摘AIM: To evaluate if traction-assisted endoscopic mucosal resection (TA-EMR) is feasible and if it enables en bloc resection of colorectal lesions. METHODS: Seven patients with a total of 12 colorectal adenomas were prospectively enrolled. All lesions were removed by TA-EMR: one hemostatic clip tied to a white silk suture was applied to the base of the lesion to allow traction through the working channel of the colonoscope. A conventional polypectomy snare was mounted over the suture and the lesion was pulled into the snare and resected in one piece. RESULTS: All 12 lesions (nine sessile) were resected en bloc with free lateral and vertical margins by using this novel technique, including five lesions (5/12, 41.6%) in less-accessible positions, where TA-EMR enabled complete visualization of the base before resection. Mean longest lesion and specimen sizes were 9 mm (range: 6-25 mm) and 11 mm in diameter (range: 7-17 mm),respectively. No serious procedure-related complications were observed. CONCLUSION: TA-EMR through the endoscope using a hemostatic clip and suture material is technically feasible. Visualization of colorectal lesions in less-accessible locations can be improved.
文摘AIM: To compare the outcomes of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) of colorectal lesions.METHODS: An electronic systematic literature search of four computerized databases was performed in July 2014 identifying studies reporting the outcomes of colorectal ESD and EMR. The primary outcome measures were en-bloc resection rate, endoscopic clearance rate and lesion recurrence rate of the patients followed up. The secondary outcome was the complication rate (including bleeding, perforation and surgery post EMR or ESD rate). Statistical pooling and random effects modelling of the studies calculating risk difference, heterogeneity and assessment of bias and quality were performed.RESULTS: Six observational studies reporting the outcomes of 1324 procedures were included. The en-bloc resection rate was 50% higher in the ESD group than in the EMR group (95%CI: 0.17-0.83, P 〈 0.0001, I2 = 99.7%). Endoscopic clearance rates were also signifcantly higher in the ESD group (95%CI: -0.06-0.02, P 〈 0.0001, I2 = 92.5%). The perforation rate was 7% higher in the ESD group than the EMR group (95%CI: 0.05-0.09, P 〉 0.05, I2 = 41.1%) and the rate of recurrence was 50% higher in the EMR group than in the ESD group (95%CI: 0.20-0.79, P 〈 0.001, I2 = 99.5%). Heterogeneity remained consistent when subgroup analysis of high quality studies was performed (with the exception of piecemeal resection rate), and overall effect sizes remained unchanged for all outcomes.CONCLUSION: ESD demonstrates higher en-bloc resection rates and lower recurrence rates compared to colorectal EMR. Differences in outcomes may beneft from increased assessment through well-designed comparative studies.
文摘Aim: To study the characteristics of EMR (endoscopic mucosal resection) or ESD (endoscopic submucosal dissection) postoperative pathological examination of colonic polyps in different age groups, and the difference of pathological examination after EMR or ESD operation. Methods: A retrospective analysis was made of the EMR or ESD postoperative pathological data of 100 cases of colonic polyps patients in the Jingzhou Central Hospital digestive internal medicine. The time is from March 2016 to March 2018. Results: In 100 cases of EMR or ESD operation, there are 65 cases of young and middle-aged group. Pathological examination results include: 34 cases of adenomatous polyp, 18 cases of inflammatory polyp, 11 cases of benign tumors, 1 case of malignant tumor, 1 case of hyperplastic polyp. There are 35 cases of elderly group. Pathological examination results include: 27 cases of adenomatous polyp, 2 cases of inflammatory polyp, 2 cases of benign tumors, 4 cases of malignant tumor. 71 cases of complete EMR operation include: 51 cases of adenomatous polyp, 17 cases of inflammatory polyp, 3 cases of benign tumors;29 cases of complete ESD operation include: 10 cases of adenomatous polyp, 3 cases of inflammatory polyp, 10 cases of benign tumors, 5 cases of malignant tumor, 1 case of hyperplastic polyp. Conclusion: For the pathological examination results after EMR or ESD operation, the proportion of inflammatory polyps in the young and middle-aged group was greater than that in the elderly group. The proportion of adenomatous polyps in the elderly group was larger than that in the young and middle-aged group. The proportion of adenomatous polyps in EMR was greater than that of ESD. The proportion of benign tumors and malignant tumors in ESD was greater than that of EMR. The difference has statistical significance.