大腸小・微小病変に対する治療と偶発症─cold snare polypectomyの病理学的評価と安全性

Safety and Pathological Evaluation of Cold Snare Polypectomy Compared to Conventional Endoscopic Mucosal Resection

要旨●10mm未満の大腸ポリープに対して，CSPまたは通電を伴う従来の内視鏡的粘膜切除術（EMR）を施行した症例を対象とし，偶発症を検討するとともに，腺腫および癌病変の病理学的断端陰性割合を検討した．EMR群1,009例中18例（1.8%）に後出血を認めたが，CSP群では797例中1例も出血を認めなかった．一方，病理学的断端については側方断端・深部断端共にCSP群で有意に陰性割合が低かった．CSPは安全な治療手技として評価できるが，完全摘除割合についてはさらなる検討が必要である．

　For cases in which CSP（cold snare polypectomy）or conventional EMR（endoscopic mucosal resection）was performed for colorectal polyps of size <10mm, the adverse events encountered and the negative resection rates of adenoma and cancer were assessed. Delayed bleeding was observed in 1.8% of 1,009 cases in the EMR group, whereas no delayed bleeding was observed among 797 cases in the CSP group. Both the horizontal and vertical resection margins showed significant lower negative resection rates in the CSP group.

　In this study, the safety of CSP was evident ; however, the negative resection rate was relatively low. Although CSP can be considered as a safe therapeutic procedure, further studies pertaining to the complete resection rate are required.