Background and Aims

Excision of all visible neoplastic tissue is the goal of EMR of colorectal laterally spreading tumors. Flat and fibrotic tissue can resist snaring. Ablation of visible polyps is associated with high recurrence rates. Avulsion is a technique to continue resection when snaring fails.

Methods

We retrospectively analyzed colonic EMRs of 564 consecutive referred polyps between 2015 and 2017. Hot avulsion was used when snaring was unsuccessful. Polyps treated with and without avulsion were compared.

Results

Hot avulsion was used in 20.9% (n = 112) of all resected lesions. The recurrence rates on follow-up colonoscopy were 17.52% in the avulsion group versus 16.02% in the non-avulsion group (P = .76). Hot avulsion was associated with a trend toward higher rates of delayed hemorrhage (5.35% vs 2.58%; P = .15) and post-coagulation syndrome (1.8% vs 0.47%; P = .15), but polyps treated with any avulsion were larger than those in which no avulsion was used (P < .001). There were an insufficient number of adverse events to perform a multivariable analysis to test the effects of avulsion, size, and location on the risk of overall adverse events.

Conclusions

Unlike previous reports of using argon plasma coagulation to treat visible polyps during EMR, hot avulsion of visible/fibrotic neoplasia was associated with similar EMR efficacy compared with cases that did not require hot avulsion. The safety profile of hot avulsion appears acceptable.

中文翻译：

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热撕脱作为EMR的安全性和有效性（带视频）

背景和目标

切除所有可见的肿瘤组织是大肠横向扩散肿瘤的EMR的目标。扁平且纤维化的组织可以抵抗困住。可见息肉的消融与高复发率有关。撕脱是一种在发现失败时继续切除的技术。

方法

我们回顾性分析了2015年至2017年间564例连续息肉的结肠EMR。当声纳未成功时使用热撕脱术。比较有和没有撕脱治疗的息肉。

结果

在所有切除的病变中，有20.9％（n = 112）使用热撕脱。撕脱组随访结肠镜检查的复发率为17.52％，非撕脱组为16.02％（P = 0.76）。热撕脱与延迟出血发生率较高（5.35％vs 2.58％；P  = .15）和凝结后综合症（1.8％vs 0.47％；P  = .15）呈趋势相关，但经任何撕脱治疗的息肉均发生比不使用撕脱术的患者要大（P  <.001）。不良事件的数量不足，无法执行多变量分析以测试撕脱，大小和位置对整体不良事件风险的影响。

结论

与先前报道的在EMR中使用氩气血浆凝结术治疗可见息肉不同，与不需要热撕脱的病例相比，热撕脱可见/纤维化赘生物与相似的EMR疗效相关。热撕脱的安全性似乎是可以接受的。