Colorectum

Some selected studies on EMR in colorectal benign/non-invasive lesions are reported in Table 6-4. The use of EMR-C in the colon is still controversial. Tada and colleagues (1996) obtained full thickness resection of the mucosal layer and one third of the submucosal layer. Some authors prefer the standard snare excision technique, as in the case of Bergmann and Beger (2003) who treated 57 patients with SP and early stage carcinoma, ranging from 10 to 50 mm. Complications occurred in two patients, in whom submucosal injection failed to raise the mucosa. Yoshikane and colleagues (1999) performed a successful "en bloc" resection in 15 of 17 colorectal tumors s 40 mm in diameter, whereas "piecemeal" resection was successful in those larger than 40 mm. Recurrence occurred in one patient with a 45 mm lesion. The percentage of bleeding ranges from 1 to 9% in some studies, whereas an increased risk, from 12 to 45%, has been experienced by other authors (see Table 6-4).

We resected 139 SP (86 in the right colon) by either snare polypectomy alone or with EMR-C. The median diameter of the lesions was 20 mm in the right colon and 30 mm in the remaining bowel. Normal saline plus epi-nephrine solution (50 to 100 cc) was injected into the sub-mucosa. EMR-C was performed in 46 patients (18 in the right colon). Bleeding occurred in 10.8% of the polyps. APC was used adjunctively in 45 patients. Invasive carcinoma was found in 17 SP and surgery was performed in 10 of them. After a median follow-up of 12.3 months, local recurrence was detected in 21.9% of polyps with no invasive cancers, and in none of the patients with invasive carcinoma who did not undergo surgery. The recurrence rate was similar regardless of the use of APC in the completion of EMR.

The recurrence rate after EMR of sessile colorectal polyps ranges between 0 to 46%, depending on the polyp size and the period of follow-up. Recurrence may occur in 100% of cases if remnants of adenoma are still in place, and the application of APC can decrease the recurrence to only 50%.

TABLE 6-4. Selected Studies on Colorectal Endoscopic Mucosal Resection

(mean [mm])

Technique

Malignancy

Complications

Follow-Up Months

Recurrence*

Doniec et al, 2003

141/186

47

S ± E

HGD: 25% (47/186), Invasive AC: 9% (7/82)

Bl: 18% (26/141), P: 1% (1/141)

40

4% (7/175)

Regula et al, 2003

82/82

29 (median)

S ± APC

Invasive AC: 9% (7/82)

Bl: 12% (10/82), Postcoagulation sdr: 2% (2/82)

37 (mean)

13% (10/78)

Bergmann et al, 2003

non polypoid lesion: 71

25.4

S or EMR-C ± SE

HGD: 21% (15/71), Early AC:11% (8/71), Advanced AC: 3% (2/71)

Bl: 1% (1/71), P: 1% (1/71)

18

3% (2/65)

Dell'Abate et al, 2001

35/104

34

S ± SS

HGD: 23% (24/104), Invasive AC: 26% (9/35)

Bl: 3% (1/35)

34 (median)

25f

Binmoeller et al, 1996

129/176

a 30

S + E

HGD: 12% (21/176), Malignant: 8% (15/176)

Bl: 45% (58/129)

20 (median)

Adenoma: 16% (19/117), AC: 28% (2/7)

Walsh et al, 1992

116/116

30

S

HGD: 7% (8/116), AC: 16% (18/116)

Bl: 9% (10/116)

33.6

28% (18/65)

AC = adenocarcinoma, APC = Argon Plasma Coagulation; Bl = bleeding; E = epinephrine; EMR = endoscopic mucosal resection; HGD = high grade dysplasia; NOS = not otherwise specified; P = perforation; S = snare; SS = saline; sdr = syndrome; SE = saline + epinephrine. *For patients with follow-up. Metachronous or recurrent.

AC = adenocarcinoma, APC = Argon Plasma Coagulation; Bl = bleeding; E = epinephrine; EMR = endoscopic mucosal resection; HGD = high grade dysplasia; NOS = not otherwise specified; P = perforation; S = snare; SS = saline; sdr = syndrome; SE = saline + epinephrine. *For patients with follow-up. Metachronous or recurrent.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

Get My Free Ebook


Post a comment