Background and Aims

Tip-in EMR, which includes anchoring the snare tip, has recently shown a favorable en-bloc and R0 resection rate for colorectal neoplasms. Thus, Tip-in EMR may be an alternative to endoscopic submucosal dissection (ESD). We aimed to compare clinical outcomes between Tip-in EMR and ESD for large colorectal neoplasms.

Methods

This retrospective study evaluated consecutive patients who underwent Tip-in EMR or ESD for 20- to 30-mm nonpedunculated colorectal neoplasms at a Japanese tertiary cancer center between January 2014 and December 2019. Baseline characteristics, treatment results, and long-term outcomes were analyzed using 1:1 propensity score matching.

Results

Seven hundred nine lesions were evaluated. The Tip-in EMR group included 1 lesion with a nonlifting sign but no lesions with fold convergence. After propensity score matching, each group included 140 lesions. The ESD group showed significantly higher en-bloc resection rates (99.3% vs 85.0%) and R0 resection rates (90.7% vs 62.9%). Procedure time was significantly shorter in the Tip-in EMR group (8 minutes vs 60 minutes). The Tip-in EMR and ESD groups did not differ significantly with respect to local recurrence rate (2.1% vs 0%).

Conclusions

Tip-in EMR is comparable with ESD with respect to the local recurrence rate but has a shorter procedure time, despite the lower en-bloc and R0 resection rates for 20- to 30-mm nonpedunculated colorectal neoplasms without fold convergence or nonlifting sign. Thus, Tip-in EMR could be a feasible alternative to ESD in these lesions.

中文翻译：

---

提示 EMR 作为内镜黏膜下剥离术的替代方法，用于治疗 20 至 30 毫米无蒂结直肠肿瘤

背景和目标

Tip-in EMR，包括固定圈套器尖端，最近显示出对结直肠肿瘤有利的整块切除率和 R0 切除率。因此，Tip-in EMR 可能是内窥镜黏膜下剥离术 (ESD) 的替代方案。我们的目的是比较Tip-in EMR 和ESD 治疗大型结直肠肿瘤的临床结果。

方法

这项回顾性研究评估了 2014 年 1 月至 2019 年 12 月期间在日本三级癌症中心接受 Tip-in EMR 或 ESD 治疗 20 至 30 毫米无蒂结直肠肿瘤的连续患者。分析了基线特征、治疗结果和长期结果使用 1:1 的倾向得分匹配。

结果

评估了 709 个病灶。Tip-in EMR 组包括 1 个有非抬高征的病灶，但没有皱襞收敛的病灶。倾向评分匹配后，每组包括140个病灶。ESD 组的整块切除率（99.3% 对 85.0%）和 R0 切除率（90.7% 对 62.9%）显着提高。Tip-in EMR 组的手术时间显着缩短（8 分钟对 60 分钟）。Tip-in EMR 和 ESD 组在局部复发率方面没有显着差异（2.1% vs 0%）。

结论

在局部复发率方面，尖端 EMR 与 ESD 相当，但手术时间更短，尽管 20 至 30 毫米无蒂结直肠肿瘤的整块切除率和 R0 切除率较低，没有折叠会聚或非提升征。因此，在这些病变中，Tip-in EMR 可能是 ESD 的可行替代方案。