Abstract

Introduction

Data supporting endoscopic resection (ER) over surgical resection (SR) for large and complex polyps come from high-volume centers. The aim of this study was to determine whether these favorable outcomes can be replicated among endoscopists at tertiary Veterans Affairs Medical Centers (VAMCs) who perform 25 to 30 ER cases a year.

Methods

Patients with adenomatous polyps or intra-mucosal cancers ≥ 2 cm in size who underwent ER or SR were identified from prospectively maintained databases at the 2 tertiary VAMCs in Veterans Integrated Service Network 6 (VISN6). The primary outcome was the rate of serious complications in the ER and SR groups.

Results

310 ER and 81 SR patients met the inclusion criteria. ER was successful in 97% of all polyps, and 93% of polyps ≥ 4 cm. The rate of serious complications was significantly lower with ER compared to SR (0.6% vs. 22%, p = 0.00001). These findings persisted even after limiting the analysis to polyps ≥ 4 cm and after propensity score matching. If all ER patients had instead undergone laparoscopic surgery, the estimated risk of a serious complication was still higher than ER for all patients (8% vs. 0.6%, p < 0.0001) but not significantly higher for polyps ≥ 4 cm (8% vs 2%, p = 0.17).

Conclusions

This study documents high success rates for ER in veterans with colorectal polyps ≥ 2 cm and ≥ 4 cm. When compared to a historical cohort of surgical patients, a strategy of attempting ER first reduced morbidity. A randomized trial is warranted to compare ER to laparoscopic surgery for polyps ≥ 4 cm.

中文翻译：

---

与具有大而复杂的结直肠息肉的退伍军人相比，内窥镜切除术可降低发病率

摘要

介绍

支持大和复杂息肉的内镜切除术（ER）优于外科切除术（SR）的数据来自大量中心。这项研究的目的是确定这些有利的结果是否可以在每年执行25至30例ER病例的第三级退伍军人事务医疗中心（VAMC）的内镜医师中复制。

方法

在退伍军人综合服务网络6（VISN6）的2个三级VAMC中，从前瞻性维护的数据库中识别出患有ER或SR的腺瘤性息肉或粘膜内癌≥2 cm的患者。主要结果是ER和SR组的严重并发症发生率。

结果

310 ER和81 SR患者符合纳入标准。ER在所有息肉中的97％和≥4 cm的息肉中占93％是成功的。与SR相比，ER引起的严重并发症发生率显着降低（0.6％比22％，p  = 0.00001）。即使将分析限制为息肉≥4 cm，并且倾向评分匹配后，这些发现仍然持续存在。如果所有ER患者都改为接受腹腔镜手术，则所有患者的严重并发症的估计风险仍高于ER（8％vs. 0.6％，p  <0.0001），但对于息肉≥4 cm的患者并没有明显增加（8％vs. 2％，p  = 0.17）。

结论

这项研究表明，在大肠息肉≥2 cm和≥4 cm的退伍军人中，ER成功率很高。与手术患者的历史队列相比，尝试ER的策略首先可降低发病率。有必要进行一项随机试验，以比较ER与腹腔镜手术对≥4 cm的息肉进行比较。