在内镜粘膜切除后腺瘤复发的治疗方法
David J Tate1,2,3, Lobke Desomer1, Maria Eva Argenziano2
1Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia.
Gut
|July 6, 2023
概括
结肠直肠多切除后的残留腺瘤是常见的,但通过内镜再处理有效治疗. 大多数患者实现长期缓解,避免手术和复杂的程序.
科学领域:
- 胃肠病学 胃肠病学
- 内視鏡外科手術 內視鏡外科手術
- 结肠直肠癌 预防 预防
背景情况:
- 大型非脚结直肠多瘤 (LNPCPs) 的内镜粘膜切除 (EMR) 后的残留或复发性腺瘤 (RRA) 是一个重要的临床挑战.
- 目前关于RRA内镜再处理结果的数据有限,缺乏建立的基于证据的标准.
研究的目的:
- 研究LNPCP的EMR后残留或复发性腺瘤内镜再治疗的疗效和长期结果.
- 评估RRA内镜治疗后的成功率和进一步干预的需要.
主要方法:
- 长达139个月的前性队列研究,记录LNPCP (≥20毫米) 在EMR后检测到的RRA的数据.
- 内镜再处理主要采用热陷切除,软凝固的冷排骨或其组合.
- 随访结肠镜检查评估了治疗的成功和需要进一步的程序.
主要成果:
- RRA发生在14.6%的患者中,通常小 (2.5-5.0毫米) 和单焦.
- 在宏观RRA的96.0%病例中,内镜治疗取得了成功.
- 长期腺瘤缓解超过90%,平均1.15次重复治疗;只有4.2%需要手术.
结论:
- 简单的内镜技术在LNPCP EMR后治疗RRA非常有效,达到>90%的长期缓解.
- 内镜再处理将更复杂,病态或资源密集的程序的需求降至最低.
- 这种方法为管理RRA提供了安全有效的标准.
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