Comparison between endoscopic mucosal resection and hot snare resection of large nonpedunculated colorectal polyps: a randomized trial
| Autor: | Akira Horiuchi, Naoki Tanaka, David Y. Graham, Toshiyuki Makino, Masashi Kajiyama, Kenji Sano |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Adenoma
Male medicine.medical_specialty Neoplasm Residual Endoscopic Mucosal Resection Operative Time Colonic Polyps Colonoscopy Endoscopic mucosal resection digestive system Complete resection law.invention Resection 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law medicine Humans Prospective Studies Prospective cohort study Aged medicine.diagnostic_test business.industry Gastroenterology Middle Aged medicine.disease digestive system diseases Tumor Burden Surgery surgical procedures operative 030220 oncology & carcinogenesis Colonic Neoplasms Female 030211 gastroenterology & hepatology Histopathology business |
| Zdroj: | Endoscopy. 48:646-651 |
| ISSN: | 1438-8812 0013-726X |
| DOI: | 10.1055/s-0042-105557 |
| Popis: | It is unclear whether endoscopic mucosal resection (EMR) or hot snare resection is better for resecting large nonpedunculated polyps. The aim of this study was to determine a cutoff size of nonpedunculated neoplastic colorectal polyps at which the risk of incomplete resection differed between EMR and hot snare resection.Patients with nonpedunculated neoplastic polyps (10 - 25 mm in diameter) were randomly assigned to undergo endoscopic resection using EMR (52 patients with 63 polyps) or hot snare resection (52 patients with 62 polyps). EMR included submucosal injection of saline before resection. The primary outcome measure was the proportion with complete polyp resection determined by histopathology. The secondary outcome was total procedure time.Patient characteristics were similar between groups. EMR achieved complete resection more frequently than hot snare resection (89 % vs. 73 %; P = 0.02), particularly for polyps ≥ 20 mm (75 % [9 /12] vs. 18 % [2 /11]; P = 0.006). A complete resection rate of 90 % was achieved for polyps of size 19 mm with EMR, and for polyps of size ≤ 14 mm with hot snare resection. In multivariate analysis, incomplete resection was associated with hot snare resection (odds ratio [OR] 2.8, 95 % confidence interval (95 %CI) 1.0 - 8.3; P = 0.04) and polyp size ≥ 15 mm (OR 4.0, 95 %CI 1.3 - 14; P = 0.01). Total procedure time was shorter with hot snare resection than with EMR (mean 14.8 min vs. 17.2 min; P 0.001).EMR and hot snare resection appear to achieve similar complete resection rates for polyps up to 14 mm; however, EMR may be superior for larger polyps, particularly for those ≥ 20 mm.Registered at Clinicaltrials.gov: NCT 01950117. |
| Databáze: | OpenAIRE |
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