EMR combined with hybrid argon plasma coagulation to prevent recurrence of large nonpedunculated colorectal polyps (with videos),Gastrointestinal Endoscopy

当前位置： X-MOL 学术 › Gastrointest. Endosc. › 论文详情

Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)

EMR combined with hybrid argon plasma coagulation to prevent recurrence of large nonpedunculated colorectal polyps (with videos)
Gastrointestinal Endoscopy ( IF 7.7 ) Pub Date : 2022-06-18 , DOI: 10.1016/j.gie.2022.06.018
Leslie Motchum ₁ , John M Levenick ₂ , Roupen Djinbachian ₃ , Matthew T Moyer ₂ , Simon Bouchard ₃ , Mahsa Taghiakbari ₄ , Alessandro Repici ₅ , Érik Deslandres ₃ , Daniel von Renteln ₃

Affiliation

Background and Aims

EMR is the mainstay of therapy for large colorectal polyps. Local recurrence after EMR is common and can be reduced using margin ablation. Our aim was to evaluate recurrence rates when using hybrid argon plasma coagulation (h-APC) ablation after EMR.

Methods

Adult patients (aged 18-89 years) undergoing EMR of nonpedunculated colorectal polyps ≥20 mm were enrolled in a prospective multicenter study. h-APC was used to ablate all defect margins and also the resection surface in selected cases. The primary study outcome was recurrence rates found during the first follow-up colonoscopy. Secondary outcomes were technical success and adverse event rates.

Results

EMR with h-APC ablation was used in 101 polyps (84 patients, 46.4% women). EMR with h-APC ablation was technically successful in all cases (median EMR time, 15 minutes; median h-APC ablation time, 4 minutes). Median polyp size was 30 mm (range, 20-60). Resected polyps were either adenomas (68/101 [67.3%]), sessile serrated lesions (27/101 [27%]), or adenocarcinomas (6/101 [6%]). The post-EMR recurrence rate was 2.2% (2/91) (95% confidence interval, .27-7.71). All 6 patients with cancer (intramucosal cancer, 4; T1sm cancer, 2) were found to have complete eradication of the primary tumor after EMR with h-APC, and none had lymph node metastasis. Four serious adverse events occurred in 3 patients (2 delayed bleeding [2.4%], 1 abdominal pain [1.2%], and 1 microperforation [1.2%]. All serious adverse events resolved with either endoscopic or antibiotic treatment only.

Conclusions

EMR with h-APC showed a high technical success rate, low adverse event rate, and very low post-EMR recurrence rates. (Clinical trial registration number: NCT04015765.)

中文翻译：

EMR 联合混合氩等离子凝固预防大的无蒂结直肠息肉复发（附视频）

背景和目标

EMR 是治疗大肠息肉的主要方法。EMR 后局部复发很常见，可以使用边缘消融来减少。我们的目的是评估 EMR 后使用混合氩等离子凝固 (h-APC) 消融术时的复发率。

方法

一项前瞻性多中心研究招募了接受无蒂结直肠息肉 ≥20 mm 的 EMR 的成年患者（年龄 18-89 岁）。h-APC 用于消融所有缺损边缘以及在选定病例中的切除表面。主要研究结果是在第一次结肠镜检查中发现的复发率。次要结果是技术成功率和不良事件发生率。

结果

101 例息肉（84 例患者，46.4% 女性）使用了带 h-APC 消融的 EMR。采用 h-APC 消融的 EMR 在所有情况下在技术上都是成功的（中位 EMR 时间为 15 分钟；中位 h-APC 消融时间为 4 分钟）。中位息肉大小为 30 毫米（范围，20-60）。切除的息肉为腺瘤 (68/101 [67.3%])、无蒂锯齿状病变 (27/101 [27%]) 或腺癌 (6/101 [6%])。EMR 后复发率为 2.2% (2/91)（95% 置信区间，0.27-7.71）。所有 6 例癌症患者（黏膜内癌，4 例；T1sm 癌，2 例）均在使用 h-APC 进行 EMR 后发现原发肿瘤完全根除，且无淋巴结转移。3 名患者发生了 4 次严重不良事件（2 例延迟出血 [2.4%]、1 例腹痛 [1.2%] 和 1 例微穿孔 [1.2%]。所有严重不良事件仅通过内镜或抗生素治疗即可解决。