Predictive factors for complications in endoscopic resection of large colorectal lesions: a multicenter prospective study

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• 作者：Yoshiki Wada ; Shin-ei Kudo ; Shinji Tanaka ; Yutaka Saito…
• 关键词：Conventional endoscopic resection ; Post procedure bleeding ; Perforation ; Large colorectal lesion
• 刊名：Surgical Endoscopy
• 出版年：2015
• 出版时间：May 2015
• 年：2015
• 卷：29
• 期：5
• 页码：1216-1222
• 全文大小：269 KB
• 参考文献：1. Fukami, N, Lee, JH (2006) Endoscopic treatment of large sessile and flat colorectal lesions. Curr Opin Gastroenterol 22: pp. 54-59 CrossRef
  2. Repici, A, Pellicano, R, Strangio, G, Danese, S, Fagoonee, S, Malesci, A (2009) Endoscopic mucosal resection for early colorectal neoplasia: pathologic basis, procedures, and outcomes. Dis Colon Rectum 52: pp. 1502-1515 CrossRef
  3. Deyhle, P, Largiader, F, Fumagalli, S (1973) A method for endoscopic electroresection of sessile colonic polyps. Endoscopy 5: pp. 38-40 CrossRef
  4. Kudo, SE (1993) Endoscopic mucosal resection of flat and depressed types of early colorectal cancer. Endoscopy 25: pp. 455-461 CrossRef
  5. Kitajima, K, Fujimori, T, Fujii, S (2004) Correlations between lymph node metastasis and depth of submucosal invasion in submucosal invasive colorectal carcinoma: a Japanese collaborative study. J Gastroenterol 39: pp. 534-543 CrossRef
  6. Ono, H, Kondo, H, Gotoda, T (2001) Endoscopic mucosal resection for treatment of early gastric cancer. Gut 48: pp. 225-229 CrossRef
  7. Oka, S, Tanaka, S, Kaneko, I (2006) Advantage of endoscopic submucosal dissection compared with EMR for early gastric cancer. Gastrointest Endosc 64: pp. 877-883 CrossRef
  8. Tanaka, S, Oka, S, Chayama, K (2008) Colorectal endoscopic submucosal dissection: present status and future perspective, including its differentiation from endoscopic mucosal resection. J Gastroenterol 43: pp. 641-651 CrossRef
  9. Uraoka T, Kawahara Y, Kato J et al (2009) Endoscopic submucosal dissection in the colorectum: present status and future prospects. Dig Endosc 21(Suppl 1):S13-6
  10. Sorbi, D, Norton, I, Conio, M (2000) Postpolypectomy lower GI bleeding: descriptive analysis. Gastrointest Endosc 51: pp. 690-696 CrossRef
  11. Church, JM (2003) Experience in the endoscopic management of large colonic polyps. ANZ J Surg 73: pp. 988-995 CrossRef
  12. Participants in the Paris Workshop (2003) The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon—November 30 to December 1, 2002. Gastrointest Endosc 58(Suppl):3-3
  13. Kudo, SE, Lambert, R, Allen, J (2008) Nonpolypoid neoplastic lesions of the colorectal mucosa. Gastrointest Endosc 68: pp. 3-29 CrossRef
  14. Japanese society for cancer of the colon and rectum (2009) Japanese classification of colorectal carcinoma. Second English Edition. Kanehara & Co. Ltd., Tokyo
  15. Schlemper, RJ, Riddell, RH, Kato, Y (2000) The Vienna classification of gastrointestinal epithelial neoplasia. Gut 47: pp. 251-255 CrossRef
  16. Rubio, CA, Nesi, G, Messerini, L (2006) The Vienna classification applied to colorectal adenomas. J Gastroenterol Hepatol 21: pp. 1697-1703 CrossRef
  17. Gossum, A, Cozzoli, A, Adler, M (1992) Colonoscopic snare polypectomy: analysis of 1485 resections comparing two types of current. Gastrointest Endosc 38: pp. 472-475 CrossRef
  18. Bedogni, G, Bertoni, G, Ricci, E (1986) Colonic excision of large and giant colorectal polyps. Technical implications and results over eight years. Dis Colon Rectum 29: pp. 831-835 CrossRef
  19. Metz, AJ,
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Surgery
  Gynecology
  Gastroenterology
  Hepatology
  Proctology
  Abdominal Surgery
  
• 出版者：Springer New York
• ISSN：1432-2218

文摘

Background and study aims Conventional endoscopic resection (CER) includes polypectomy and endoscopic mucosal resection. The most common complications related to these techniques are post procedure bleeding and perforation. The aim of this study was to evaluate the outcomes of CER for colorectal neoplasms ?0?mm and to clarify predictive factors for complications. Patients and methods We conducted a multicenter prospective study at 18 specialized institutes. From October 2007 to December 2010, 1,029 CERs were performed at participating institutes. We collected the data prospectively and analyzed gender, age, tumor size, gross appearance, mode of resection, etc. Results The mean size of polyps resected was 26.4?±?8.6?mm (range 20-20?mm). The final pathology was Vienna classification category 1 or 2 in 24, category 3 in 502, and category 4 or 5 in 503 lesions. Post procedure bleeding and intra procedure perforation occurred, respectively, in 16 (1.6?%) and 8 cases (0.78?%). The overall complication rate was 2.3?%. Risk factors for bleeding in multivariate analysis were only patients under 60?years of age. Risk factors for perforation in multivariate analysis were en bloc resection and Vienna classification category 4-. The difference of complication rate was not statistically significant regarding gender, size, tumor location, gross appearance, treatment method, and kind of insufflation. Conclusion CER is a safe, efficient, and effective minimally invasive therapy for large colorectal lesions. However, care should be taken for post procedure bleeding in patients under 60?years of age and for perforation in cases of Vienna classification category 4- or when an en bloc resection is tried.