水下内镜粘膜切除术治疗 10-20 毫米结直肠锯齿状病变的安全性和有效性（SEA CLEAR 研究）。

IF 6.7 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gastrointestinal endoscopy Pub Date : 2025-03-01 DOI:10.1016/j.gie.2024.08.040

Kosuke Tanaka MD , Yohei Yabuuchi MD , Kenichiro Imai MD, FJGES , Kazuya Hosotani MD , Shuko Morita MD , Kazunori Takada MD , Yoshihiro Kishida MD, PhD, FJGES , Sayo Ito MD , Kinichi Hotta MD, FJGES , Keita Mori PhD , Tetsuro Inokuma MD, PhD , Hiroyuki Ono MD, PhD

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引用次数: 0

摘要

背景和目的：结直肠锯齿状病变（SLs）是通过锯齿状瘤形成途径发生结直肠癌的前兆。然而，内镜下切除大的锯齿状病变的成功率很低。因此，本研究旨在确定水下内镜粘膜切除术（UEMR）治疗 10-20 毫米大小 SL 的安全性和有效性：这项双中心前瞻性观察研究纳入了至少有一个 10-20 毫米大小 SL 的患者。我们通过 UEMR 手术切除了 SL，并在切除部位进行了纹身。术后 12 个月进行结肠镜监测，以评估局部复发情况。主要结果是UEMR的完全切除率，其定义为全块切除，4个边缘活检中无锯齿状组织，组织学边缘阴性：结果：58 名患者的 65 个 SL 接受了 UEMR，中位病灶大小为 14 毫米。全切率、R0切除率和完全切除率分别为87.7%（57/65）、61.5%（40/65）和60.0%（39/65）。不良事件包括1例（1.5%）即刻出血和1例（1.5%）延迟穿孔。对 50 名患者的 57 个疤痕进行了监视性结肠镜检查，纹身和疤痕的识别率分别为 94.7%（54/57）和 100%（57/57）。复发率为 5.3%（3/57），所有三个复发病灶均在内镜下完全切除：这项由两个中心进行的前瞻性研究表明，UEMR 对 10-20 毫米大小的 SL 的治疗效果与之前的传统内镜粘膜切除术相当。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Safety and efficacy of underwater EMR for 10- to 20-mm colorectal serrated lesions (SEA CLEAR study)

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Safety and efficacy of underwater EMR for 10- to 20-mm colorectal serrated lesions (SEA CLEAR study)

Background and Aims

Colorectal serrated lesions (SLs) are precursors of colorectal carcinoma via the serrated neoplasia pathway. However, the success rate of endoscopic resection of large SLs is low. Therefore, this study aimed to determine the safety and efficacy of underwater EMR (UEMR) for SLs sized 10 to 20 mm.

Methods

This 2-center, prospective, observational study included patients with at least 1 SL sized 10 to 20 mm. We resected the SLs by UEMR and performed tattooing at the resection site. Surveillance colonoscopy was performed 12 months postoperatively to evaluate local recurrence. The primary outcome was the complete resection rate of UEMR, which was defined as en bloc resection with no serrated tissue in the 4 marginal biopsy samples and histologically negative margins.

Results

UEMR was performed for 65 SLs in 58 patients, with a median lesion size of 14 mm. The en bloc, R0 resection, and complete resection rates were 87.7% (57 of 65), 61.5% (40 of 65), and 60.0% (39 of 65), respectively. Adverse events included 1 (1.5%) immediate bleeding and 1 (1.5%) delayed perforation. Surveillance colonoscopy was performed in 50 patients with 57 scars, and the rates of identification for tattoos and scars were 94.7% (54 of 57) and 100% (57 of 57), respectively. The recurrence rate was 5.3% (3 of 57), and all 3 recurrent lesions were completely resected endoscopically.

Conclusions

This 2-center prospective study demonstrated that UEMR for SLs sized 10 to 20 mm was comparable to previous conventional EMR outcomes.

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来源期刊

Gastrointestinal endoscopy 医学-胃肠肝病学

CiteScore

10.30

自引率

7.80%

发文量

1441

审稿时长

38 days

期刊介绍： Gastrointestinal Endoscopy is a journal publishing original, peer-reviewed articles on endoscopic procedures for studying, diagnosing, and treating digestive diseases. It covers outcomes research, prospective studies, and controlled trials of new endoscopic instruments and treatment methods. The online features include full-text articles, video and audio clips, and MEDLINE links. The journal serves as an international forum for the latest developments in the specialty, offering challenging reports from authorities worldwide. It also publishes abstracts of significant articles from other clinical publications, accompanied by expert commentaries.