ENDOSCOPIC MUCOSAL RESECTION OF SESSILE POLYPOID COLORECTAL LESIONS: A TWO-YEAR RETROSPECTIVE STUDY, TECHNIQUE DESCRIPTION, INDICATIONS AND COMPLICATIONS
Autori:
Pave Markoš, Tomislav Brkić, Roland Pulanić, Jasenka Jakić-Razumović, Hrvoje Iveković, Marina Premužić, Mirjana Kalauz, Milorad Opačić, Nadan Rustemović, Boris Vucelić
Sažetak
Uvod: Endoskopska mukozna resekcija (EMR) terapijska je metoda resekcije premalignih lezija i intramukoznih karcinoma probavne cijevi. Do sada nisu objavljeni podaci o EMR-u u Hrvatskoj. Materijali i metode: Pacijenti uključeni u retrospektivnu analizu liječeni su u Kliničkome bolničkom centru Zagreb od prosinca 2006. do prosinca 2008. g. Za izvođenje EMR-a upotrebljavana je strip metoda s pomoću submukozne injekcije adrenalina (razrjeđenje s fiziološkom otopinom 1:5.000–10.000). Rezultati: EMR sesilnih polipoidnih lezija debelog crijeva izvedena je u 95 pacijenata. Najčešća lokalizacija lezija bio je rektum (52 pacijenta – 54,7%), a najčešća veličina bila je između 16 i 25 mm (43 pacijenta – 45%). U 75 pacijenata učinjena je en-bloc, a u ostalih piecemeal resekcija. Neposredno nakon EMR-a krvarenje je nastupilo kod 5 pacijenata (5,3%). Najčešća patohistološka dijagnoza bila je vilotubularni adenom (67 pacijenata – 70%). U 6 pacijenata (6,3%) verificiran je invazivni, a u 20 pacijenata (21%) intramukozni karcinom. Na kontrolnoj endoskopiji nije nađen recidiv lezije u 73 (77%) pacijenata. Kirurški zahvat bio je potreban kod 6 pacijenata zbog dijagnoze invazivnog karcinoma. Zaključak: EMR je sigurna i pouzdana metoda odstranjenja premalignih lezija i intramukoznih karcinoma debelog crijeva s malim rizikom od teških komplikacija i prihvatljivim postotkom rezidua osnovne lezije.
Summary
Introduction: Endoscopic mucosal resection (EMR) is a therapeutic method for removal of sesile premalignant lesions and intramucosal carcinoma of the gastrointestinal tract. No reports on EMR data in Croatia have been published yet. Matherials and methods: All patients included in the study were managed at the University Hospital Centre Zagreb between December 2006 and December 2008. EMR was performed using strip technique with submucosal injection of epinephrine (dilution with saline 1:5000–10000). Results: EMR of sessile polypoid colorectal lesions was performed in 95 patients. The most common localisation of the disease was rectum (52 pts – 54.7%). In most patient size of the lesion was between 16–25 mm (43 pts – 45%). En-bloc resection was performed in 75 patients and piecemeal resection in the rest. Bleeding occurred immediately during the EMR in 5 pts (5.3%). Patohistological diagnosis revealed tubulovillous adenoma in 67 pts (70%). Invasive carcinoma was observed in 6 pts (6.3%) and intramucosal carcinoma in 20 pts (21%). On follow up, 73 pts (77%) did not show and sign of disease recurrence. Surgery was needed in 6 pts (6.3%) due to the diagnosis of invasive carcinoma. Conclusion: EMR is safe and reliable method with low risk of serious complications and acceptable recurrence rate.
