Background: endoscopic electroexcision is the standard technique for the removal of colorectal polyps. However, it is associated with the postoperative morbidity. In order to reduce the incidence of complications, “cold” excision seems to be an alternative option.Aim: to improve the results of endoscopic treatment for patients with colorectal polyps.Patients and methods: from September 2019 to September 2020, 160 patients ≥ 18 years old (80 in each group), who underwent endoscopic removal of colorectal polyps ≤ 10 mm in size by cold excision (132 lesions) and traditional polypectomy (129 lesions), were included in a prospective randomized trial. All removed specimens were studied histologically with an assessment of the resection margins (R0/R1). The analysis of the postoperative complications after endoscopic polypectomy and the incidence of Rx resection after removal of polyps by both techniques was done.Results: the compared groups were homogenous in the number of patients, gender, age, and comobridities. There were no significant differences in the number of removed polyps, their site and the type according to endoscopic classifications. The operation time was significantly higher in the conventional polypectomy group compared with the “cold” one (p = 0.0001). There were no significant differences in the intraoperative complications rate between the two groups (p = 0.06). There were no postoperative complications in the “cold” group. In the control group postoperative complications occurred after 12 out of 129 polyps removal (p = 0.001). The univariate analysis showed that a risk factor for the development of postoperative complications after conventional polypectomy is the lack of submucosal lifting (OR: 15.3, 95% CI: 1.9-125.6, p = 0.01). Histopathology of the removed specimens showed that in both groups most of the procedures were considered as R0 resections (54% in the main group, 56.4% in the control group, p = 0.8). The polyp size ≤ 4 mm identified as a risk factor for R1, Rx resection (OR: 2.4, 95% CI: 1.3–4.7, p = 0.007).Conclusion: “cold” polypectomy is an effective and safe method and may be recommended as an alternative technique for the removal of non-pedunculated colorectal polyps ≤ 10 mm.
Цель -оптимизация тактики клинического ведения пациентов с плоскими новообразованиями толстой кишки путем улучшения качества их уточняющей диагностики. Материал и методы. Оценены и сопоставлены результаты эндоскопической и морфологической диагностики 152 плоских, уплощенных и плоско-углубленных эпителиальных новообразований толстой кишки, обнаруженных у 86 больных (42 женщины и 44 мужчины) в возрасте от 39 до 79 лет. Видеоэндоскопическая диагностика проводилась путем колоноскопии с дополненным хромоскопией осмотром в белом свете в узком спектре света и с использованием функции увеличения изображения. При анализе изображений обнаруженных новообразований и оценке характера последних применялись клинических классификаций NICE, S. Kudo, T. Kimura, Y. Sano. Результаты. При рутинном осмотре в белом свете диагностическая точность метода в выявлении гиперпластических полипов составила 70%, сидячих зубчатых аденом -95%, доброкачественных аденом -92%, малигнизированных аденом -100%. Применение уточняющих технологий продемонстрировало сопоставимую диагностическую точность: гиперпластические полипы правильно диагностированы в 72% случаев, зубчатые образования -в 96%, доброкачественные аденомы -в 94% и малигнизированные аденомы -в 100% случаев. Заключение. При наличии определенных практических навыков и соответствующей базовой подготовки врача-эндоскописта рутинная эндоскопия (исследование в белом свете) в диагностике плоских, уплощенных и плоско-углубленных новообразований толстой кишки по показателю диагностической точности практически не уступает исследованию с использованием современных технологий уточняющей эндоскопической диагностики. Основанные на оценке исключительно визуальной эндоскопической картины диагностические выводы, содержащие предположения о вероятной морфологической структуре обнаруженных плоских новообразований, приближаются по точности к результатам морфологической идентификации последних. Aim. The objective of the present study was the optimization of the strategy for the treatment of the patients presenting with squamous epithelial neoplasms in the colon by improving the quality of their corrective diagnostics. Materials and methods. The study was designed to evaluate and compare the results of endoscopic and morphological diagnostics of 152 flat, flattened, and flat-penetrating squamous epithelial neoplasms of the colon detected in 86 patients (42 women and 44 men at the age from 39 to 79 years). The videoendoscopic diagnostics was carried out by means of colonoscopy in the combination with chromoscopy in the narrow-spectrum white light and with the use of the image magnification function. The analysis of neoplasm images and the evaluation of their character was based on the NICE, S. Kudo, T. Kimura, and Y. Sano classifications. Results. The diagnostic accuracy of the method employed during the routine examination in visible light for the detection of hyperplastic polyps was 70%, sessile serrated adenomas 95%, benign adenomas 92%, and malignized adenomas 100%. The application of the clarifying techno...
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