#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Účinnost léčby lokální reziduální neoplazie za standardizovaných podmínek


Authors: Ondřej Urban 1,2;  Barbora Pipek 1;  Ivana Mikoviny Kajzrlíková 3;  Přemysl Falt 1,2;  Petr Fojtík 1;  Petr Vítek 1
Authors‘ workplace: Digestive Diseases Center, Vítkovice Hospital, Ostrava 1;  Faculty of Medicine, University of Ostrava, Ostrava 2;  Beskydy Gastrocenter, Frýdek-Místek Hospital, Frýdek-Místek 3
Published in: Vnitř Lék 2016; 62(5): 365-369
Category: Original Contributions

Overview

Cíl studie:
Endoskopická slizniční resekce „po částech“ (endoscopic mucosal resection – EMR) je metodou volby v léčbě nepolypoidních neoplastických lézí tlustého střeva > 20 mm. Nicméně, až v 15 % případů dochází v jizvě po EMR ke vzniku lokální reziduální neoplazie (local residual neoplasia – LRN). Cílem naší prospektivní intervenční studie bylo posouzení účinnosti léčby LRN za standardizovaných podmínek.

Metodika:
Ve 2 neuniverzitních endoskopických centrech byly LRN léze ošetřeny ve shodě s nově navrženou klasifikací založenou na endoskopickém vzhledu LRN, a to buď argonovou plazmakoagulací (APC), endoskopickou slizniční resekcí (EMR) nebo endoskopickou submukózní disekcí (ESD). Primární sledovaný parametr, účinnost léčby LRN, byl definován jako endoskopická a histologická absence neoplastické tkáně v jizvě po EMR 6 měsíců po léčbě LRN.

Výsledky:
Celkem bylo do studie zařazeno 25 pacientů s 25 LRN lézemi. Mezi nimi bylo léčeno 12 pacientů (48 %) pomocí APC, 8 pacientů (32 %) pomocí EMR a 5 pacientů (20 %) pomocí ESD s účinností v 90,9 %, 87,5 % a 100 % případů.

Závěr:
Při použití standardizovaného přístupu řízeného morfologií LRN lézí může dojít k eradikaci neoplastické tkáně v 91,3 % případů po jediném sezení endoskopické léčby.

Klíčová slova:
endoskopická slizniční resekce – koloskopie – lokální reziduální neoplazie


Sources

1. Winawer SJ, Zauber AG, Ho MN et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med 1993; 329(27): 1977–1981.

2. Cottet V, Jooste V, Fournel I et al. Long term risk of colorectal cancer after adenoma removal: a population-based cohort study. Gut 2012; 61(8): 1180–1186.

3. Løberg M, Kalager M, Holme Ø et al. Long-term colorectal-cancer mortality after adenoma removal. N Engl J Med 2014; 371(9): 799–807.

4. Hassan C, Repici A, Sharma P et al. Efficacy and safety of endoscopic resection of large colorectal polys: a systematic review and meta-analysis. Gut 2015; 65(5): 806–820. Dostupné z DOI: <http://dx.doi.org/10.1136/gutjnl-2014–308481>.

5. Belderbos TD, Leenders M, Moons L et al. Local reccurence after endoscopic mucosal resection of nonpedunculated colorectal lesions: systematic review and meta-analysis. Endoscopy 2014; 46(5): 388–402.

6. Lieberman DA, Rex DK, Winaver SJ et al. United States Multi-Society Task Force on Colorectal Cancer. Guidelines for colonoscopy surveillance after screening polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2012; 143(3): 844–857.

7. Robertson DJ, Greenber ER, Beach M et al. Colorectal cancer in patients under close colonoscopic surveillance. Gastroenterology 2005; 129(1): 34–41.

8. Farrar WD, Sawhney MS, Nelson DB et al. Colorectal cancers found after a complete colonoscopy. Clin Gastroenterol Hepatol 2006; 4(10): 1259–1264.

9. Loeve F, van Ballegooijen M, Boer R et al. Colorectal cancer risk in adenoma patients: a nation-wide study. Int J Cancer 2004; 111(1): 147–151.

10. Paris Workshop Participants. The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon. Gastrointest Endosc 2002; 58(6 Suppl): S3-S43.

11. Le Roy F, Manfredi S, Hamonic S et al. Frequency of and risk factors for the surgical resection of non-malignant colorectal polyps: a population-based study. Endoscopy 2016; 48(3): 263–270.

12. Atkin WS, Morson BC, Cuzick J. Long term risk of colorectal cancer after excision or rectosigmoid adenomas. N Eng J Med 1992; 326(10): 658–662.

13. Rotondano G, Bianco MA, Buffoli F et al. The cooperative Italian FLIN study group: prevalence and clinicopathological features of colorectal laterally spreading tumors. Endoscopy 2011; 43(10): 856–861.

14. Saito Y, Fujii T, Kondo H et al. Endoscopic treatment for laterally spreading tumors in the colon. Endoscopy 2001; 33(8): 682–686.

15. Moss A, Bourke MJ, Williams SJ et al. Endoscopic mucosal resection outcomes and prediction of submucosal cancer from advanced colonic mucosal neoplasia. Gastroenterology 2011; 140(7): 1909–1918.

16. Tanaka S, Haruma K, Oka S et al. Clinicopathologic features and endoscopic treatment of superficially spreading colorectal neoplasms larger than 20 mm. Gastrointest Endosc 2001; 33(8): 682–686.

17. Hurlstone DP, Sanders DS, Cross SS et al. Colonoscopic resection of lateral spreading tumours: a prospective analysis of endoscopic mucosal resection. Gut 2004; 53(9): 1334–1339.

18. Kaltenbach T, Friedland S, Maheshwari A et al. Short- and long-term outcomes of standardized EMR of nonpolypoid (flat and depressed) colorectal lesions > or = 1 cm (with video). Gastrointest Endosc 2007; 65(6): 857–865.

19. Urban O, Vitek P, Fojtik P et al. Laterally spreading tumors-experience based on 138 consecutive cases. Hepatogastroenterology 2008; 55(82–83): 351–355.

20. Urban O, Kijonkova B, Kajzrlikova IM et al. Local residual neoplasia after endoscopic treatment of laterally spreading tumors during 15 months of follow-up. Eur J Gastroenterol Hepatol 2013; 25(6): 733–738.

21. Moss A, Williams SJ, Hourigan LF et al. Long term adenoma reccurence following wid-field endoscopic muscosal resection (WF-EMR) for advanced colonic mucosal neoplasia is infrequent: results and ris factors in 1000 cases from the Australian Colonic EMR (ACE) study. Gut 2015; 64(1): 57–65.

22. Matsuda K, Masaki T, Abo Y et al. Rapid growth of residual colonic tumor after incomplete mucosal resection. J Gastroenterol 1999; 34(2): 260–263.

23. Kunihiro M, Tanaka S, Haruma K et al. Electrocautery snare resection stimulates cellular proliferation of residual colorectal tumor: an increasing gene expression related to tumor growths. Dis Colon Rectum 2000; 43(8): 1107–1115.

24. Toyonaga T, Man-i M, Fujita T et al. Retrospective study of technical aspects and complications of endoscopic submucosal dissection of laterally spreading tumors of the colorectum. Endoscopy 2010; 42(9): 714–722.

25. Saito Y, Fukuzawa M, Matsuda T et al. Clinical outcome of endoscopic submucosal dissection versus endoscopic mucosal resection of large colorectal tumors as determined by curative resection. Surg Endosc 2010; 24(4): 345–352.

26. Farhat S, Chaussade S, Ponchon T et al. [SFED ESD study group]. Endoscopic submucosal dissection in a European setting. A multi-institutional report of a technique in development. Endoscopy 2011; 43(8): 664–670.

27. Cairns SR, Scholefield JH, Steele RJ et al. [British Society of Gastroenterology; Association of Coloproctology for Great Britain and Ireland]. Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups (update from 2002). Gut 2010; 59(5): 666–689.

28. Knabe M, Pohl J, Gerges C et al. Standardized long-term follow-up after endoscopic resection of large non-pedunculated colorectal lesions: a prospective two-center study. Am J Gastroenterol 2013; 109(2): 183–189.

29. Zlatanic J, Waye JD, Kim PS et al. Large sessile colonic adenomas: use of argon plasma coagulator to supplement piecemeal snare polypectomy. Gastrointest Endosc 1999; 49(6): 731–735.

30. Regula J, Wronska E, Polkowski M et al. Argon plasma coagulation after piecemeal polypectomy of sessile colorectal adenomas: long term follow-up study. Endoscopy 2003; 35(3): 212–218.

Labels
Diabetology Endocrinology Internal medicine
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#