对于大型 (≥15毫米) 平坦的非形结直肠多瘤的冷或热陷内镜粘膜切除:一个随机对照试验
Timothy O'Sullivan1,2, Oliver Cronin1,2, W Arnout van Hattem3
1Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia.
与热陷EMR (H-EMR) 相比,冷陷内镜粘膜切除 (C-EMR) 显示大结肠聚体的安全性更好. 然而,C-EMR的复发率更高,限制了其目前的使用.
科学领域:
- 胃肠病学 胃肠病学
- 内镜手术是一种内镜手术.
- 胃肠道瘤学 胃肠道瘤学
背景情况:
- 热陷内镜粘膜切除 (H-EMR) 对大型非脚结直肠多片 (LNPCPs) 有效,但存在风险.
- 冷陷EMR (C-EMR) 提供了一个潜在的更安全的替代方案,但证据有限.
研究的目的:
- 为了比较C-EMR与LNPCP的H-EMR的疗效和安全性.
- 评估与每个技术相关的复发率,出血和穿孔.
主要方法:
- 一项随机试验,涉及177名患有平坦,腺瘤性LNPCP (15-50毫米) 的患者.
- 患者被分配到C-EMR或H-EMR中,并进行边缘热废除.
- 主要结局是6个月监测后的复发;次要结局包括出血和穿孔.
主要成果:
- 技术成功率高且可比:C-EMR的98.9%,H-EMR的100%.
- 与H-EMR (1.1%) 相比,C-EMR (18.4%) 的复发率显著更高 (p<0.001).
- 临床显著的EMR后出血在H-EMR (7.8%) 和C-EMR (1.1%) (p=0.034) 之间较高.
结论:
- 对于LNPCP来说,C-EMR显示出更高的安全性和相当于H-EMR的技术成功.
- 与C-EMR一起更高的内镜复发率是当前的限制.
- 进一步的研究可能会优化C-EMR以减轻复发,同时保持安全效益.
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