真实世界无蒂结直肠息肉切除技术选择的单中心回顾性分析

A real‑world single‑center retrospective analysis of technique options for sessile colorectal polypectomy

摘要:

目的 分析不同长径的无蒂结直肠息肉使用冷活检钳息肉切除术（cold forcep polypectomy，CFP）、冷圈套器息肉切除术（cold snare polypectomy，CSP）或内镜黏膜切除术（endoscopic mucosal resection，EMR）在真实世界中的使用情况。方法 回顾性纳入2022年1月至2023年12月北京协和医院消化内科切除的长径≤19 mm无蒂结直肠息肉12 290个（10 295例患者），由30名内镜医师完成息肉切除术。根据息肉长径分为1~5 mm、>5~10 mm及>10~19 mm三组，比较各组内切除方式的差异。在长径>5~10 mm组的息肉中，分析行CSP者金属夹使用情况及2022年与2023年>5~10 mm息肉切除方式的变化。结果 1~5 mm无蒂息肉（8 289个）以CFP切除（6 769个，81.7%）为主。>5~10 mm无蒂息肉（2 455个）切除以CSP（1 372个，55.9%）为主，但不同医师之间CSP的使用率差异较大，中位使用率52.9%（40.3%，60.0%）。>10~19 mm无蒂息肉（1 546个）以EMR切除（1 349个，87.3%）为主。2023年>5~10 mm无蒂息肉切除中CSP使用率64.2%（869/1 354）较2022年45.7%（503/1 101）明显升高。>5~10 mm无蒂息肉CSP中金属夹总体使用率为40.1%（550/1 372），在不同医师之间有较大差异，中位使用率48.3%（29.8%，67.9%）。结论 内镜医师对于长径≤19 mm无蒂结直肠息肉的切除方法存在较大差异，1~5 mm息肉主要采用CFP，>5~10 mm息肉以CSP为主且使用率逐年增加，>10~19 mm息肉则主要采用EMR。CSP中金属夹使用率在不同医师间存在显著差异。

Abstract:

Objective To analyze the real-world practices of resecting sessile colorectal polyps of varying long diameters using cold forcep polypectomy (CFP), cold snare polypectomy (CSP), or endoscopic mucosal resection (EMR). Methods A total of 12 290 nonpedunculated colorectal polyps of long diameter ≤19 mm (from 10 295 patients) were retrospectively enrolled from January 2022 to December 2023. Polypectomy was conducted by 30 endoscopists. The polyps were categorized into three groups based on long diameter: 1-5 mm, >5-10 mm and >10-19 mm, and the differences of polypectomy methods were compared in three groups. The usage of hemostatic clips in CSP among >5-10 mm polyps and the changes in resection methods between 2022 and 2023 were analyzed. Results CFP (6 769 polyps, 81.7%) was the predominant method for resecting 1-5 mm sessile polyps (8 289 polyps). For sessile polyps sized >5-10 mm (2 455 polyps), CSP was used most (1 372, 55.9%), although its utilization varied significantly among physicians with the median usage rate of 52.9% (40.3%, 60.0%). EMR (1 349 poolyps, 87.3%) was the main method for >10-19 mm sessile polyps. The usage rate of CSP in sessile polypectomy for polyps >5-10 mm significantly increased from 45.7% (503/1 101) in 2022 to 64.2% (869/1 354) in 2023. The overall frequency of using clip in CSP for >5-10 mm sessile polyps was 40.1% (550/1 372), demonstrating notable variability among different endoscopists with median usage rate of 48.3% (29.8%, 67.9%). Conclusion Varied resection methods are observed among endoscopists for sessile polyps measuring ≤19 mm. CFP is primarily utilized for polyps of 1-5 mm, while CSP is favored for polyps >5-10 mm, with an increasing annual usage rate. EMR is the main approach for the polyps >10-19 mm. Additionally, notable variations in the use of metal clips during CSP are observed among different physicians.