کد مقاله | کد نشریه | سال انتشار | مقاله انگلیسی | نسخه تمام متن |
---|---|---|---|---|
6097417 | 1210289 | 2015 | 9 صفحه PDF | دانلود رایگان |
![عکس صفحه اول مقاله: Original articleClinical endoscopyImproving complete EMR of colorectal neoplasia: a randomized trial comparing snares and injectate in the resection of large sessile colon polyps Original articleClinical endoscopyImproving complete EMR of colorectal neoplasia: a randomized trial comparing snares and injectate in the resection of large sessile colon polyps](/preview/png/6097417.png)
BackgroundThere are few randomized studies examining efficacy of snares and agents in EMR.ObjectiveTo compare the use of a combined needle and snare unit with injectate versus a spiral wire and injectate (primary); saline solution versus hydroxypropyl methylcellulose (secondary).DesignProspective, randomized, factorial, single center.SettingTertiary-care academic medical center.PatientsA total of 140 patients with large (>15 mm), sessile, colorectal polyps.InterventionsPolyps randomized to either 1 of 2 snare types and 1 of 2 injectates.Main Outcome MeasurementsPrimary-the Sydney resection quotient (SRQ), defined as the size of the polyp divided by the number of pieces resected and the amount of tissue per snare attempt. Secondary-procedure time, adverse events, residual neoplasia at follow-up.ResultsThe SRQ was higher with the combined unit (median 13.8 mm vs 7.1 mm; P = .019); additionally, procedure time was less (median 6 vs 11 minutes; P < .001). Resection was considered complete after the EMR in 62% (42/68) with the combined needle and snare unit versus 51% (37/72; P = .22) with the spiral wire. Rates of adverse events were similar. Residual neoplasia was found at follow-up in 22% (10/46) with the combined needle and snare unit versus 21% (10/48; P = .89) with the spiral wire. There was no evidence of differences in outcomes by lifting agent.LimitationsThe SRQ is only a surrogate marker.ConclusionThis study provides evidence that the integrated needle-snare may be superior to the snare alone for the removal of large, flat polyps. Additionally, the type of injectate appears to have no impact on outcome.
Journal: Gastrointestinal Endoscopy - Volume 81, Issue 3, March 2015, Pages 673-681