老年大肠广基息肉内镜黏膜切除术的临床研究

目的探讨内镜黏膜切除术（EMR）对老年广基息肉病变的治疗价值及安全性。方法采用结肠镜下大肠黏膜切除术治疗117例共157枚大肠广基息肉。病灶黏膜下注射肾上腺素生理盐水后,一次圈套整块切除或分次圈套切除病变,回收标本送病理检查,术后结肠镜随访。结果全部息肉通过EMR一次切除,切除息肉大小在1～5cm范围;腺瘤性息肉141枚,增生性息肉13枚;局灶癌变3例（病理证实）。4例出现腹痛,3例少量便血,发烧4例,不需要特殊处理。复查患者未有息肉残留者。腺瘤息肉异型增生程度与息肉大小密切相关（P〈0.05）。结论老年大肠广基息肉通过EMR切除完全,安全;腺瘤息肉的大小与异型增生密切相关,提示腺瘤息肉需要早期干预治疗。     

黏膜切除术治疗结直肠广基隆起性腺瘤性息肉98例临床研究

目的探讨内镜下黏膜切除术(endoscopic mucosal resection,EMR)治疗结直肠广基隆起性腺瘤性息肉患者的疗效。方法回顾性分析98例结直肠广基隆起性腺瘤性息肉(息肉直径0.6~2.0 cm)患者的临床资料并行EMR治疗。结果 98例均经电子结肠镜检查及术前病理诊断为腺瘤性息肉,均为广基隆起性病变,共120枚,行EMR,留取完整标本病理检查,创面均给予钛夹封闭。术后病理诊断为腺瘤性息肉113例,高级别瘤变4例,局部癌变3例,7例切缘均无癌细胞,未追加外科手术。1个月后复查见病变部位黏膜光滑,未见息肉及病变黏膜残留。高级别瘤变及局部癌变7例随访3年,未见肿瘤复发及它处转移。结论对于广基隆起性腺瘤性息肉行EMR较既往单纯的高频电灼或氩离子凝固术有助于发现早期癌,改善患者的预后。     

内镜下黏膜切除术治疗消化道肿瘤

目的 探讨内镜下黏膜切除术(EMR)对消化道肿瘤的治疗价值。方法 利用染色、放大内镜及超声内镜探测病变范围及侵犯深度,对位于黏膜层及黏膜肌层的早期癌、癌前病变、黏膜下肿瘤、侧向发育型息肉、无蒂或亚蒂巨大息肉、息肉癌变等病变行EMR治疗。结果 病灶最大直径6cm。2例早期食管癌、1例早期贲门癌、1例早期大肠癌及2例胃中、重度异型增生经EMR及透明帽负压吸引EMR切除,观察3-18个月无复发;31例黏膜下肿瘤经EMR和透明帽负压吸引EMR,均完全切除;对13例侧向发育型息肉及21例亚蒂和无蒂大息肉及局部癌变息肉采用EMR或分片黏膜切除术切除。术中出血5例,出血率7.04％,经内镜治疗停止。1例4.5 cm腺瘤术后3个月复发。结论 在超声内镜、色素内镜及放大内镜的指导下,采用内镜下黏膜切除术治疗部分消化道早期癌、癌前病变、侧向发育型及无蒂或亚蒂臣大息肉、局部癌变息肉及黏膜肌层的肿瘤,足一项安全有效的内镜治疗疗法。     

内镜黏膜切除术治疗结肠广基息肉临床疗效分析

目的分析结肠息肉的临床病理特点以及应用内镜黏膜切除术治疗结肠广基息肉的有效性和安全性。方法收集我院2012年8月到2014年1月由结肠镜诊断经内镜黏膜切除术(EMR)进行息肉切除的324例结肠息肉患者的临床资料,所切除息肉均符合EMR指征。观察手术并发症、处理措施和术后病理结果,分析EMR治疗结肠息肉的完整切除率、并发症发生率及复发率。结果共切除463枚息肉,直径6~45 mm,大于20 mm的息肉共65枚;息肉最易发生部位为直肠;病理类型以管状腺瘤最为多见。除2例不完全切除外均完整切除,标本完整切除率为99.6%。术中及术后并发症发生率2.6%,其中消化道出血7例(1.5%),以腹痛为主要表现的息肉切除术后综合征5例(1.1%),无消化道穿孔。直径大于20 mm的息肉EMR术后12个月复查肠镜,无复发。结论采用EMR治疗即使是直径大于20 mm的结肠息肉也是安全、有效的首选方法。     

改良内镜黏膜切除术治疗结肠扁平息肉的临床应用

目的 评价改良内镜黏膜切除术(M-EMR)治疗结肠扁平息肉疗效。方法 将276例297枚结肠扁平息肉患者随机分成两组：EMR组136例共152枚息肉,M-EMR组140例共145枚息肉。病灶黏膜下注射生理盐水后,EMR组一次性切除病灶,M-EMR组在病灶周边用圈套器头端切开周边黏膜后一次性切除病灶,回收全部标本送病理检查。比较术后两组并发症发生率,手术时间,完整切除率,术后复发率。结果 全部息肉一次性切除。EMR组1例迟发出血,1例穿孔,1例电凝综合征,并发症发生率2.0%(3/152);M-EMR组1例迟发出血,1例电凝综合征,并发症发生率1.4%(2/145)。EMR组息肉切除时间平均(5.6±2.0)min;M-EMR组息肉切除时间平均(5.7±2.1)min,2组无显著差异(p>0.05)。EMR组息肉完整切除率92.1％(140／152),M-EMR组息肉完整切除率100％(145／145),2组显著差异(p<0.05)。术后病理：管状腺瘤135例,绒毛状腺瘤40例,绒毛管状腺瘤57例,增生性息肉29例,炎性息肉34例。腺瘤伴高级别类瘤变8例,其中EMR组1例息肉残留,后行肠段切除,6个月后8例复查无复发。M-EMR组2例黏膜内癌,完整切除,6个月后复查无复发。EMR组12例术后残留,1例手术,11例APC处理后,1例6个月复发,复发率0.66%(1／152),M-EMR组无复发。结论 M-EMR组较EMR组治疗结肠扁平息肉更有效。     

大肠癌精筛中内镜黏膜切除术对结直肠进展期腺瘤的诊治价值

目的探讨内镜黏膜切除术(EMR)在大肠癌精筛中诊治结直肠进展期腺瘤的临床价值。方法收集2016-01～2017-05广州市中西医结合医院结肠镜活检诊断为结直肠广基或亚蒂进展期腺瘤52例,行EMR切除病灶,并行病理学检查明确诊断,随访观察治疗效果和安全性。结果 47例病变予EMR切除,5例予内镜黏膜分片切除术(EPMR)切除,术中出血5例,均20 ml,术后无迟发型出血及穿孔发生。所有病变一次性整块切除率为90. 4%(47/52),组织治愈性切除率为88. 5%(46/52);术后病理提示绒毛状腺瘤或管状绒毛状腺瘤伴低级别上皮内瘤变(LGD) 38例(73. 1%),绒毛状腺瘤或管状绒毛状腺瘤伴高级别上皮内瘤变(HGD) 12例(23. 1%),另有2例(3. 8%)黏膜下癌转外科手术治疗,但术后病变肠段未发现肿瘤组织残留和淋巴结转移。50例患者术后随访3～15月(中位随访9个月)未见复发。结论 EMR诊治进展期腺瘤安全有效,在大肠癌精确筛查中能发挥关键的诊治价值。     

内镜下黏膜切除术治疗老年人大肠息肉

目的 研究内镜下黏膜切除术(EMR)对老年人大肠息肉的治疗效果,并对其临床病理特征、适应证、并发症等进行讨论.方法 2003年10月至2008年10月共完成老年人大肠息肉EMR手术277例,共计413枚.对切除标本进行病理组织学观察,术后定期内镜随访1～60月,以评价切除效果,记录术中及术后发生的并发症及处理情况.结果 413枚息肉中393枚经首次或再次EMR治疗病变完整清除,治愈率为95.2%;15枚(占3.6%,15例患者)术后病理示浸润癌再追加外科开腹手术.术中出血16例(5.8%),均内镜下止血成功;术后迟发出血5例(1.8%),其中3例经内镜下止血成功,2例经输血及内科保守治疗后出血停止.无穿孔、感染及其他并发症发生.病理结果示炎性息肉、增生性息肉、腺瘤性息肉、腺瘤癌变分别占25.7%(106/413),19.1%(79/413),50.4%(208/413),4.8%(20/413),老年人随着年龄的增加,腺瘤性息肉的比例逐渐升高(P＜0.01).随访期间所有病例均无复发.结论 EMR是一种安全和微创的内镜治疗手段,对老年人大肠息肉治疗的效果优于传统的内镜下治疗方法.     

内镜下黏膜切除术治疗早期大肠癌

目的探讨内镜下黏膜切除术治疗早期大肠癌的安全性及治疗效果。方法对26例早期大肠癌患者进行内镜下黏膜切除术切除病变,观察并发症、术后病理及术后内镜随访情况。结果一次性完整切除病变24例,分2块全部切除2例。术中出血2例(发生率7.7%),予止血夹钳夹止血。术后无出血及穿孔等并发症。术后病理:25例黏膜内癌,1例黏膜下癌,切缘距离病变超过2 mm,无肿瘤组织残留,无血管及淋巴管侵犯。26例病变均完全切除,术后6个月复查结肠镜2例创面见息肉样组织增生,予高频电切除,病理诊断为黏膜组织慢性炎,其余病例创面形成瘢痕,无肿瘤复发。1年后复查结肠镜病变均无复发。此后每年复查结肠镜,原切除部位无肿瘤复发。结论内镜下黏膜切除术治疗早期大肠癌是安全、有效的,在完全切除病变的前提下,可达到根治效果。     

内镜下黏膜切除术治疗老年及老年前期胃肠道息肉的临床研究

目的探讨内镜下黏膜切除术（endoscopic mucosal resection,EMR）对老年及老年前期胃及大肠息肉的治疗效果,并对其临床病理特征、适应证、并发症等进行讨论。方法 2003年10月至2009年10月共完成老年及非老年胃息肉及大肠息肉EMR手术1076例;对切除标本进行病理检查,记录术中及术后发生的并发症及处理情况,术后定期内镜随访1-60月。结果 348处胃息肉经首次或再次EMR治疗病变均完整清除,病理示炎性息肉、增生性息肉、腺瘤性息肉分别占62.6%（218/348）,27.9%（97/348）,9.5%（33/348）。935处大肠息肉中892处病变经首次或再次EMR治疗病变完整清除,治愈率为95.4%;23处病变（2.5%）术后病理示浸润癌再追加外科开腹手术。病理示炎性息肉、增生性息肉、腺瘤性息肉、腺瘤癌变分别占29.1%（272/935）,20.9%（195/935）,46.2%（432/935）,3.9%（36/935）,随年龄的增加,腺瘤性息肉的比例逐渐升高（P〈0.01）。术中出血52例（4.8%）,均内镜下止血;术后迟发出血（〉24 h）21例（2.0%）,其中15例经内镜下止血,6例经输血及内科保守治疗后止血。无穿孔、感染等并发症发生。随访期间所有病例均无复发。结论 EMR是一种安全和微创的内镜治疗手段,对老年及老年前期胃及大肠息肉治疗的疗效优于传统的内镜下治疗方法。     

内镜下黏膜切除术治疗老年及老年前期大肠息肉561例

目的:观察内镜下黏膜切除术(EMR)对老年及老年前期大肠息肉的疗效,并对其临床病理特征、适应证及并发症等进行探讨.方法:2003-10/2008-10我院消化内科内镜中心老年及非老年大肠息肉EMR手术561例766处病变,对切除标本进行病理组织学观察.术后定期内镜随访1-60 mo,以评价切除效果,记录术中及术后发生的并发症及处理情况.结果:766处病变总治愈率96.3%;21处病变(2.7%,21例)术后病理示浸润癌再追加外科开腹手术.术中出血23例(4.1%),均内镜下止血成功:术后迟发出血10例(1.8%):7例经内镜下止血成功,3例经输血及内科保守治疗后出血停止;无穿孔、感染及其他并发症发生.病理结果示炎性息肉、增生性息肉、腺瘤性息肉、腺瘤癌变分别占29.0%,21.1%,45.7%,4.2%,随着年龄的增加,腺瘤性息肉的比例逐渐升(P<0.01).随访期间所有病例均无复发.结论:EMR是一种安全、微创的内镜治疗手段,对老年及老年前期大肠息肉治疗的效果优于传统的内镜下治疗方法.     

Endoscopic Removal of Large Colorectal Polyps

PURPOSE: Because of the potential risk of malignancy and technical difficulties in achieving complete removal, large colorectal polyps represent a special problem for the endoscopist. The aim of this study was to evaluate the capabilities and risks of endoscopy in complete removal of large colorectal polyps. METHODS: Endoscopic polypectomy of 186 colorectal polyps larger than 3 cm in diameter (range, 3-13 cm) was performed; 141 were sessile and 45 pedunculated. Most of the polyps were located in the rectum (n = 88), sigmoid (n = 63), and cecum (n = 9). The remaining adenomas were situated in other parts of the colon. Sessile polyps were removed using the piecemeal technique. RESULTS: Histology results showed an adenoma in 167 cases, and invasive carcinoma was present in the adenoma in 19 patients. Of the adenomas, 29 were tubulous, 118 tubulovillous, and 20 villous; adenoma with severe dysplasia was found in 49 cases. Complete endoscopic removal was achieved in all sessile and pedunculated polyps. None of the patients with invasive carcinoma who underwent surgical resection (n = 10) had any evidence of tumor in the resected specimen. Bleeding occurred in 4 patients after polypectomy (2 percent). Perforation occurred in 1 patient (0.5 percent), who had an invasive carcinoma of the cecum. There was no procedure-related mortality. During a mean follow-up period of 40 (range, 3-87) months, 6 patients presented with recurrence of a benign adenoma (3 percent), which was treated endoscopically, and 1 patient presented with a recurrent invasive carcinoma, which was treated surgically. CONCLUSIONS: Endoscopic polypectomy is a safe and effective method of treating large colorectal polyps.     

LARGE HYPERPLASTIC POLYP DEVELOPING AFTER ENDOSCOPIC MUCOSAL RESECTION OF GASTRIC ADENOMA IN A PATIENT RECEIVING IMMUNOSUPPRESSIVE THERAPY

A 59‐year‐old man underwent endoscopic mucosal resection (EMR) for gastric adenoma. He had suffered from end‐stage renal disease for several years and had received renal transplantation some 5 months before EMR. Subsequently, he took immunosuppressive agents. Follow‐up gastrofiberscopy 6 months after EMR showed a sessile polyp at the resection site twice as large as the original adenoma; biopsy specimens revealed a hyperplastic nature. At the time of writing, this hyperplastic polyp has neither increased in size nor developed adenomatous or carcinomatous changes by histological examinations over the past 5 years. Therefore, this is a case of hyperplastic polyp occurring at the gastric adenoma resection site, and suggests the possible effect of immunosuppressive therapy on the post‐EMR healing process and hyperplastic polyp development.     

Large endoscopic mucosal resection for colorectal tumors exceeding 4 cm

AIM:To evaluate the feasibility and the outcome of endoscopic mucosal resection(EMR)for large colorectal tumors exceeding 4 cm(LCRT)undergoing piecemeal resection. METHODS:From January 2005 to April 2008,146 digestive tumors larger than 2 cm were removed with the EMR technique in our department.Of these,34 tumors were larger than 4 cm and piecemeal resection was carried out on 26 colorectal tumors.The mean age of the patients was 71 years.The mean follow-up duration was 12 mo. RESULTS:LCRTs were located in ...     

Flat gastric polyps: results of forceps biopsy, endoscopic mucosal resection, and long-term follow-up

OBJECTIVE: Histological examination of specimens obtained by forceps biopsy sampling of gastric polyps is of limited accuracy, and their management on this basis is therefore controversial. The aim of this prospective study was to assess the value of forceps biopsy sampling in establishing the correct diagnosis revealed by endoscopic mucosal resection (EMR). The complication rate of EMR was also determined. MATERIAL AND METHODS: Subjects with gastric polyps of epithelial origin, of at least 0.5 cm in diameter, and not associated with polyposis syndromes, were included in the study. Between 1994 and 2004, 56 gastric polyps in 44 patients (30 F, 14 M, mean age 67 years) met the inclusion criteria. Indigo carmine dye staining and electronic magnification were used in all cases. Following forceps biopsy sampling, 56 EMRs were performed. The histological results of the forceps biopsy and the resected specimens were analyzed. RESULTS: The initial forceps biopsies identified in situ carcinoma in 3 cases, adenoma with no dysplasia in 19, adenoma with low-grade dysplasia in 2, adenoma with moderate-grade dysplasia in 6, adenoma with high-grade dysplasia in 7, and hyperplastic lesions in 19 cases. The histological examination of the resected polyps revealed in situ carcinoma in 5 cases, carcinoid in 1, gastrointestinal stromal tumor in 1, adenoma with no dysplasia in 14, adenoma with low-grade dysplasia in 3, adenoma with moderate-grade dysplasia in 9, adenoma with high-grade dysplasia in 1, hyperplastic lesions in 21, and no diagnosis in 1 case. Complete agreement between the histological results on the forceps biopsy sample and on the ectomized polyp was seen in only 31 (55.3%) polyps. There were important disagreements in 12 cases. In 14 neoplastic and 1 hyperplastic polyps, the degree of dysplasia seen on histological examination of the forceps biopsy specimens differed from that observed for the resected specimens. Post-mucosectomy bleeding was observed in 3 patients, all of whom were successfully treated endoscopically. CONCLUSIONS: Forceps biopsy is not sufficiently reliable for the identification of gastric polyps. These lesions should be fully resected by EMR for a final diagnosis and (depending on the lesion size and type) possibly definitive treatment.     

Endoscopic mucosal resection of 161 cases of large sessile or flat colorectal polyps

OBJECTIVE: Large sessile or flat colorectal polyps, which are traditionally treated surgically, may be amenable to endoscopic mucosal resection (EMR), often using a piecemeal method. Appropriate selection of lesions and a careful technique may enhance the efficacy of EMR for polyps >or=20 mm in diameter without compromising safety. The aim of this study was to identify the factors that may be predictive of the risk of polyp recurrence. MATERIAL AND METHODS: A retrospective analysis was conducted on the outcome of 161 polyps >or=20 mm in diameter, treated by piecemeal EMR at a single centre using the "lift and cut" technique. All records were reviewed for polyp size, site, morphology and histology. Polypectomy technique, patient follow-up, polyp recurrence and surgical interventions were also recorded. RESULTS: Over an 8-year period, 161 colonic polyps measuring >or=20 mm were removed by EMR. Follow-up data were available for 149 cases (93%) with a mean polyp diameter of 32.5 mm; the total success rate of endoscopic polyp removal was 95.4%. The number of cases requiring 1, 2, 3, 4 and 6 attempts at EMR was 89 (60%), 36 (24%), 14 (9%), 2 (1.3%) and 1 (0.7%), respectively. Recurrence was significantly related to polyp size (p<0.001). There was no statistically significant relationship between site and recurrence. Seven patients (4.6%) underwent surgical intervention after EMR because of failed clearance. There were no post-EMR perforations and significant bleeding was reported in only two patients (1.7%). CONCLUSIONS: With careful attention to technique, piecemeal EMR is a safe option for the resection of most sessile and flat colorectal polyps >or=20 mm in size. A stricter follow-up may be required for larger lesions because of a higher risk of recurrence.     

Endoscopic mucosal resection of large hyperplastic polyps in 3 patients with Barrett＇s esophagus

AIM: To report the endoscopic treatment of large hyperplastic polyps of the esophagus and esophago-gastric junction (EGJ) associated with Barrett's esophagus (BE) with low-grade dysplasia (LGD), by endoscopic mucosal resection (EMR). METHODS: Cap fitted EMR (EMR-C) was performed in 3 patients with hyperplastic-inflammatory polyps (HIPs) and BE. RESULTS: The polyps were successfully removed in the 3 patients. In two patients, with short segment BE (SSBE) (<= 3 cm), the metaplastic tissue was completely excised. A 2 cm circumferential EMR was performed in one patient with a polyp involving the whole EGJ. A simultaneous EMR-C of a BE-associated polypoid dysplastic lesion measuring 1 cm multiply 10 cm, was also carried out. In the two patients, histologic assessment detected LGD in BE. No complications occurred. Complete neosquamous re-epithelialization occurred in the two patients with SSBE. An esophageal recurrence occurred in the remaining one and was successfully retreated by EMR. CONCLUSION: EMR-C appears to be a safe and effective method for treating benign esophageal mucosal lesions, allowing also the complete removal of SSBE.     

Recurrence after endoscopic piecemeal mucosal resection for large sessile colorectal polyps

AIM: To evaluate the safety and outcomes of endoscopic piecemeal mucosal resection (EPMR) for large sessile colorectal polyps. METHODS: The patients enrolled in this study were 47 patients with 50 large sessile polyps (diameter, 2 cm or greater) who underwent EPMR using a submucosal saline injection technique between December 2002 and October 2005. All medical records, including characteristics of the patients and polyps, complications, and recurrences, were retrospectively reviewed. The first follow-up end...