Histological Comparison of Cold versus Hot Snare Resections of the Colorectal Mucosa.
Dis Colon Rectum
; 61(8): 964-970, 2018 08.
Article
em En
| MEDLINE
| ID: mdl-29944582
ABSTRACT
BACKGROUND:
Delayed postpolypectomy bleeding occurs more frequently after hot resection than after cold resection.OBJECTIVE:
To elucidate the underlying mechanism, we performed a histological comparison of tissue after cold and hot snare resections.DESIGN:
This is a prospective study, registered in the University Hospital Medical Information Network (UMIN000020104).SETTING:
This study was conducted at Aizu Medical Center, Fukushima Medical University, Japan. PATIENTS Fifteen patients scheduled to undergo resection of colorectal cancer were enrolled. INTERVENTION On the day before surgery, 2 mucosal resections (hot and cold) of normal mucosa were performed on each patient using the same snare without saline injection. The difference was only the application of electrocautery or not. Resection sites were placed close to the cancer to be included in the surgical specimen. MAIN OUTCOMEMEASURES:
The primary outcome measure was the depth of destruction. Secondary outcome measures included the width of destruction, depth of the remaining submucosa, and number of vessels remaining at the resection sites. The number and diameter of vessels in undamaged submucosa were also evaluated.RESULTS:
All cold resections were limited to the shallow submucosa, whereas 60% of hot resections advanced to the deep submucosa and 20% to the muscularis propria (p < 0.001). There was no significant difference in the width of destruction. The number of remaining large vessels after hot resections trended toward fewer (p = 0.15) with a decreased depth of remaining submucosa (p = 0.007). In the deep submucosa, the vessel diameter was larger (p < 0.001) and the number of large vessels was greater (p = 0.018).LIMITATIONS:
Histological assessment was not blinded to the 2 reviewers. Normal mucosa was used instead of adenomatous tissue.CONCLUSIONS:
Hot resection caused damage to deeper layers involving more large vessels. This may explain the mechanism for the reduced incidence of hemorrhage after cold snare polypectomy. See Video Abstract at http//links.lww.com/DCR/A631.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Neoplasias Colorretais
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Pólipos do Colo
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Hemorragia Pós-Operatória
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Criocirurgia
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Eletrocoagulação
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Lesões do Sistema Vascular
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Ressecção Endoscópica de Mucosa
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Mucosa Intestinal
/
Complicações Intraoperatórias
Tipo de estudo:
Diagnostic_studies
/
Etiology_studies
/
Observational_studies
/
Risk_factors_studies
Limite:
Aged
/
Female
/
Humans
/
Male
País/Região como assunto:
Asia
Idioma:
En
Revista:
Dis Colon Rectum
Ano de publicação:
2018
Tipo de documento:
Article
País de afiliação:
Japão