Zusammenfassung
Hintergrund: Heutzutage stellt die endoskopische Resektion die Standardprozedur bei der Abtragung kolorektaler Polypen dar. Vor der Etablierung endoskopischer Techniken kam der Abtragung kolorektaler Polypen mit einer Größe von über 3 cm eine eindeutige Präferenz zu. Die Sicherheit und Effektivität der endoskopischen Abtragung von Polypen über 3 cm wurden in zahlreichen Studien belegt. Patienten und Methodik: Es wurden Daten von 165 Patienten (Alter 68 ± 10,4 Jahre) mit insgesamt 167 Polypen evaluiert. Die Polypen wiesen eine Mindestgröße von 3 cm auf. Im Blickpunkt des Interesses war die makroskopische und histologische Morphologie der Polypen, die Lokalisation im Kolon, die Modalitäten der Polypabtragung sowie das Follow-up. Patienten mit makroskopisch eindeutig malignitätsverdächtigen Polypen wurden ausgeschlossen. Ergebnisse: Erfolgreich endoskopische Abtragungen gelangen in 72,5 %. Dabei war in 73,6 % aller Resektionen die Anwendung der Piecemeal-Technik erforderlich. Rezidive traten nach kompletten Resektionen in 26,3 % (nach einem mittleren Follow-up von 16 ± 12,5 Monaten) auf. Es lag eine Komplikationsrate von 19,2 % vor. Relevante Blutungen und Perforationen wurden als frühe Komplikationen in 18,6 % registriert. Eine interventionsbedingte Mortalität wurde nicht festgestellt. Schlussfolgerung: Endoskopische Mukosaresektionen stellten eine sichere und effiziente Methode zur Abtragung großer kolorektaler Polypen dar. Kontrolluntersuchungen sollten in zeitlich definierten Abständen zur Detektion von Rezidivpolypen erfolgen.
Abstract
Background: Today, endoscopic resection is a standard procedere for the resection of colonic polyps. Before the establishment of endoscopic techniques, the surgical approach was a clearly preferred method for removal of polyps with a size larger than three centimeters. The safety and effectiveness concerning endoscopic resections of colorectal polyps also with a size of more than 3 cm have been demonstrated in numerous studies. Patients and Methods: Data from 165 patients (age: 68 ± 10.4 years) harboring 167 polyps with a minimum diameter of 3 cm were retrospectively evaluated. Objects of interest were macroscopic morphology and histopathology of the polyps, their localization in the colon, the modality of endoscopic resection and follow-up. In those cases with macroscopic signs of malignancy the patients were excluded. Results: Successful endoscopic resections were obtained in 72.5 %. Therefrom, resection in the piecemeal-technique was necessary in 73.6 %. Recurrence polyps after endoscopic complete resections occurred in 26.3 % after a mean follow-up of 16 ± 12.5 months. We registered a complication rate of 19.2 %. Relevant bleeding and perforation were registered as early complications in 18.6 %. We observed no intervention-related mortality. Conclusion: Endoscopic mucosal resection is a safe and efficient method even for removing giant colorectal polyps. Controls are recommended at defined intervals for detecting polyp recurrence.
Schlüsselwörter
Giant Polyps - kolorektales Adenom - endoskopische Resektion - rezidivierende Polypen
Key words
giant polyps - colorectal adenoma - endoscopic resection - recurring polyps
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1 Rico Hochdörffer and Axel Eickhoff are both first authors, because both are involved in creation of the manuscript in equal parts.
Dr. Rico Hochdörffer
Medical Department C, Klinikum der Stadt Ludwigshafen a. R.
Bremserstr. 79
67063 Ludwigshafen am Rhein
Germany
Phone: ++ 49/6 21/5 03 41 01
Fax: ++ 49/6 21/5 03 41 14
Email: rico.hochdoerffer@gmx.de