Cold versus hot snare endoscopic mucosal resection for large (≥15 mm) flat non-pedunculated colorectal polyps: a randomised controlled trial

医学 粘膜切除术 穿孔 结肠镜检查 外科 随机对照试验 内科学 射频消融术 胃肠病学 息肉切除术 内窥镜检查 结直肠癌 烧蚀 癌症 材料科学 冲孔 冶金
作者
Timothy E. O’Sullivan,Oliver Cronin,W. Arnout van Hattem,Francesco Vito Mandarino,Julia Gauci,Clarence Kerrison,Anthony Whitfield,Sunil Gupta,Eric Lee,Stephen J. Williams,Nicholas G. Burgess,Michael J. Bourke
出处
期刊:Gut [BMJ]
卷期号:73 (11): 1823-1830 被引量:15
标识
DOI:10.1136/gutjnl-2024-332807
摘要

Background and aims Conventional hot snare endoscopic mucosal resection (H-EMR) is effective for the management of large (≥20 mm) non-pedunculated colon polyps (LNPCPs) however, electrocautery-related complications may incur significant morbidity. With a superior safety profile, cold snare EMR (C-EMR) of LNPCPs is an attractive alternative however evidence is lacking. We conducted a randomised trial to compare the efficacy and safety of C-EMR to H-EMR. Methods Flat, 15–50 mm adenomatous LNPCPs were prospectively enrolled and randomly assigned to C-EMR or H-EMR with margin thermal ablation at a single tertiary centre. The primary outcome was endoscopically visible and/or histologically confirmed recurrence at 6 months surveillance colonoscopy. Secondary outcomes were clinically significant post-EMR bleeding (CSPEB), delayed perforation and technical success. Results 177 LNPCPs in 177 patients were randomised to C-EMR arm (n=87) or H-EMR (n=90). Treatment groups were equivalent for technical success 86/87 (98.9%) C-EMR versus H-EMR 90/90 (100%); p=0.31. Recurrence was significantly greater in C-EMR (16/87, 18.4% vs 1/90, 1.1%; relative risk (RR) 16.6, 95% CI 2.24 to 122; p<0.001). Delayed perforation (1/90 (1.1%) vs 0; p=0.32) only occurred in the H-EMR group. CSPEB was significantly greater in the H-EMR arm (7/90 (7.8%) vs 1/87 (1.1%); RR 6.77, 95% CI 0.85 to 53.9; p=0.034). Conclusion Compared with H-EMR, C-EMR for flat, adenomatous LNPCPs, demonstrates superior safety with equivalent technical success. However, endoscopic recurrence is significantly greater for cold snare resection and is currently a limitation of the technique. Trial registration number NCT04138030
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
PDF的下载单位、IP信息已删除 (2025-6-4)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
2秒前
2秒前
轩轩完成签到,获得积分10
3秒前
夏侯绮山发布了新的文献求助10
3秒前
务实涔发布了新的文献求助10
3秒前
好好学习完成签到,获得积分10
4秒前
独特冰安发布了新的文献求助10
4秒前
handan发布了新的文献求助10
5秒前
whysoserious完成签到,获得积分10
5秒前
nihao完成签到,获得积分10
6秒前
程雯慧完成签到,获得积分10
6秒前
6秒前
沉尘发布了新的文献求助10
7秒前
行为艺术家发布了新的文献求助200
7秒前
花生什么树完成签到,获得积分10
8秒前
酷炫依凝完成签到,获得积分10
9秒前
10秒前
XY发布了新的文献求助10
10秒前
11秒前
CodeCraft应助我爱学习采纳,获得10
11秒前
斯文败类应助内丹翠采纳,获得10
12秒前
13秒前
量子星尘发布了新的文献求助10
13秒前
汏流萤完成签到,获得积分10
13秒前
英俊的铭应助哼哼唧唧采纳,获得10
13秒前
猪猪hero应助wjx采纳,获得10
13秒前
丰富的绮波完成签到 ,获得积分10
13秒前
王赞应助wjx采纳,获得10
13秒前
14秒前
15秒前
Shelton发布了新的文献求助10
16秒前
科研通AI2S应助石慧敏采纳,获得10
16秒前
小蘑菇应助li采纳,获得10
17秒前
18秒前
洗刷刷发布了新的文献求助10
19秒前
Orange应助夏侯绮山采纳,获得10
19秒前
独特冰安发布了新的文献求助10
20秒前
20秒前
花生什么树关注了科研通微信公众号
20秒前
现代的bb发布了新的文献求助10
21秒前
高分求助中
Picture Books with Same-sex Parented Families: Unintentional Censorship 700
ACSM’s Guidelines for Exercise Testing and Prescription, 12th edition 500
Nucleophilic substitution in azasydnone-modified dinitroanisoles 500
不知道标题是什么 500
Indomethacinのヒトにおける経皮吸収 400
Phylogenetic study of the order Polydesmida (Myriapoda: Diplopoda) 370
Effective Learning and Mental Wellbeing 300
热门求助领域 (近24小时)
化学 材料科学 医学 生物 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 遗传学 基因 物理化学 催化作用 冶金 细胞生物学 免疫学
热门帖子
关注 科研通微信公众号,转发送积分 3975375
求助须知:如何正确求助?哪些是违规求助? 3519718
关于积分的说明 11199471
捐赠科研通 3256067
什么是DOI,文献DOI怎么找? 1798075
邀请新用户注册赠送积分活动 877386
科研通“疑难数据库(出版商)”最低求助积分说明 806305