识别不可能:碎片冷陷阱切除穿孔

Q3 Medicine
Hyun Jae Kim MD , Douglas Motomura MD , Eric C.S. Lam MD, MSc , Neal Shahidi MD, PhD
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引用次数: 0

摘要

背景与目的由于其良好的安全性,渐次冷陷阱切除术(CSR)被越来越多地应用于大型非带梗结肠直肠息肉的治疗。虽然不良事件很少发生,但CSR后穿孔的报道并不多见。我们提出了一个视频病例的过程中穿孔在碎片CSR。方法一名63岁的静止性结肠克罗恩病患者行发育不良监测,发现多发扁平息肉,包括2个相邻的0-IIA大横结肠息肉。用进色剂和10毫米冷诱捕器进行逐条CSR。粘膜下色内窥镜仔细检查切除基底,发现IV型深壁损伤,尽管没有电灼。使用贯穿范围的夹子将缺陷闭合。观察患者并使用抗生素出院,随访时无延迟不良事件。组织病理学证实无发育不良的无柄锯齿状病变。结论本病例表明,虽然少见,但在CSR过程中仍可能发生穿孔。内窥镜医师应进行细致的切除基础评估,因为没有烧灼可能会掩盖深部壁损伤的迹象。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Identifying the impossible: piecemeal cold snare resection perforation

Background and Aim

Piecemeal cold snare resection (CSR) is an increasingly adopted technique for large nonpedunculated colorectal polyps because of its favorable safety profile. Although adverse events are rare, perforation after CSR has been reported infrequently. We present a video case of intraprocedural perforation during piecemeal CSR.

Methods

A 63-year-old woman with quiescent colonic Crohn disease underwent dysplasia surveillance, revealing multiple flat polyps, including 2 adjacent large 0-IIA transverse colon polyps. Piecemeal CSR was performed using chromoinjectate and a 10-mm cold snare. Careful inspection of the resection base with submucosal chromoendoscopy revealed a type IV deep mural injury, despite the absence of electrocautery. The defect was closed using through-the-scope clips. The patient was observed and discharged with antibiotics, with no delayed adverse events at follow-up. Histopathology confirmed sessile serrated lesions without dysplasia.

Conclusion

This case demonstrates that perforation, although rare, can occur during CSR. Endoscopists should perform meticulous resection base assessments, as the absence of cautery may obscure signs of deep mural injury.
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来源期刊
VideoGIE
VideoGIE Medicine-Gastroenterology
CiteScore
1.50
自引率
0.00%
发文量
132
审稿时长
105 days
期刊介绍: VideoGIE, an official video journal of the American Society for Gastrointestinal Endoscopy, is an Open Access, online-only journal to serve patients with digestive diseases. VideoGIE publishes original, single-blinded peer-reviewed video case reports and case series of endoscopic procedures used in the study, diagnosis, and treatment of digestive diseases. Videos demonstrate use of endoscopic systems, devices, and techniques; report outcomes of endoscopic interventions; and educate physicians and patients about gastrointestinal endoscopy. VideoGIE serves the educational needs of endoscopists in training as well as advanced endoscopists, endoscopy staff and industry, and patients. VideoGIE brings video commentaries from experts, legends, committees, and leadership of the society. Careful adherence to submission guidelines will avoid unnecessary delays, as incomplete submissions may be returned to the authors before initiation of the peer review process.
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