ESD And EPMR Clinical Analysis In The Treatment Of Colorectal Polyps ≥20mm

Objective:To evaluate the ef~Afic~bac~sy~t a~rnd~a ~csa~tfety of three treatment modalities,including endoscopic submucosal dissection(ESD),endoscopic piecemeal mucosal resection(EPMR),for the treatment of colorectal polyps measuring≥20mm.Methods:A retrospective analysis was performed on 79 patients with colorectal polyps measuring≥20mm who visited the Department of Gastroenterology at Anqing Municipal Hospital between January 2018 and December 2021.Patients were divided into three groups according to different endoscopic treatment methods:ESD group,EPMR group,and ESD+EPMR group.The therapeutic effects,postoperative complications,and recurrence rates of polyps treated with ESD and EPMR were observed and compared.In addition,the characteristics of polyps at different sites and postoperative complications were analyzed.The main outcome measures included bleeding,perforation,margin involvement,the need for additional surgical intervention postoperatively,and the recurrence rate within 1 year after surgery.All patients were followed up with at least one colonoscopy within 1 year postoperatively to observe the recurrence status.Results:1、There was no significant difference in clinical baseline data among the three groups(P>0.05).However,there was a significant difference in the history of previous polyp treatment among the different surgical methods(P<0.05).There were significant differences in polyp size and morphology among the three different surgical methods(P<0.05).2、The rates of bleeding,perforation,additional surgical intervention,and recurrence within 1 year postoperatively were compared among the three groups.The bleeding rate in the EPMR group was 5.71%,with no perforations,no additional surgical interventions,and a 1-year postoperative recurrence rate of 5.71%.The bleeding rate in the ESD group was 5.13%,with a perforation rate of 2.56%,an additional surgical intervention rate of 7.69%,and a 1-year postoperative recurrence rate of 2.56%.There was one case of bleeding in the ESD+EPMR group,but no perforation or recurrence requiring surgical intervention was reported.There were no significant differences in the rates of these outcomes among the three groups(P>0.05).3、The costs,surgical time,and length of hospital stay were compared among three groups.The EPMR group had costs of 9341.29±4385.81 yuan,surgical time of 12.51±3.79 minutes,and length of hospital stay of 7.54±5.57 days.The ESD group had costs of20257.34±9731.19 yuan,surgical time of 25.03±10.04 minutes,and length of hospital stay of 11.79±4.67 days.The combined ESD and EPMR group had costs of 26198.89±6964.95 yuan,surgical time of 29.00±14.83 minutes,and length of hospital stay of15.60±7.13 days.There was a significant increasing trend between the three groups(P<0.05).4、The characteristics of polyp-related indicators were analyzed.The study analyzed the features of polyps at different sites and cell dysplasia,and found that they did not show significant differences with age,height,weight,smoking,drinking,hypertension,diabetes,and basal morphology(P>0.05).In addition,there were significant differences in gender and history of previous polyp treatment among polyps at different sites(P<0.05).The features of different-sized polyps were also analyzed,and it was found that they showed significant differences only in the level of CA199(U/ml)(P<0.05).5、The features of adverse events were analyzed.The study analyzed the characteristics of bleeding and found that it did not show significant differences with all the influencing factors in this study.For bleeding and perforation,there were no significant differences among different surgical methods(P>0.05).Conclusion:All three surgical methods can effectively treat colorectal polyps≥20mm.Among them,EPMR is more cost-effective and has a shorter hospital stay.Its adverse reactions are better than the other methods when the polyp size is less than 30mm.Therefore,EPMR is recommended for the treatment of colorectal polyps with a size between 20-30mm.For polyps larger than 30mm,ESD or ESD combined with EPMR is recommended.