INTESTINE Vol.22 No.2(4)


「個人年間予約購読者用全文閲覧サービス」でこの号を見る
特集名 内視鏡治療の偶発症と対策
題名 大腸EMR（cold polypectomyを含む）の偶発症の実態─文献のreview
発刊年月 2018年 02月
著者 樫田 博史 近畿大学医学部消化器内科
【 要旨 】 大腸のホットバイオプシー（HFP），ポリペクトミー（HSP），EMRの偶発症について文献のreviewを行った．HFP，HSP，EMRにおける後出血postprocedural bleeding (PPB)の頻度は，それぞれ0.29～0.38％，0.92～1.5％，1.02～1.4％であるが，病変が大きいほうが高く，20 mm以上では1.96～11％と報告されている．HFP，HSP，EMRにおける穿孔率は，それぞれ0.01～0.05％，0.02～0.05％，0.09～0.63％と報告され，20 mm以上でも1％弱である．cold polypectomyに関しては，術中出血（IPB）は1.77～9.13％とやや多めだが，PPBは通電する手技より低率の0～0.3％であり，穿孔は皆無であった．文献によって，前向きか後ろ向きか，対象病変径，偶発症の定義，頻度は患者当りか病変当りか，などに留意してデータを比較する必要がある．
Theme Countermeasures of adverse events in therapeutic endoscopy
Title Complications of colorectal endoscopic resection including cold polypectomy ; a review of the literature
Author Hiroshi Kashida Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine
[ Summary ] A systematic review concerning complications from colorectal hot forceps polypectomies (HFP), hot snare polypectomies (HSP) and endoscopic mucosal resection (EMR) was conducted. The respective rates of postprocedural bleeding (PPB) for HFP, HSP, EMR were 0.29-0.38 %, 0.92-1.5 % and 1.02-1.4 %. However, rates were higher in larger lesions ; 1.96-11 % in those >20 mm. The respective rates of perforation for HFP, HSP, EMR were 0.01-0.05 %, 0.02-0.05 %, 0.09-0.63 % and the rates were no higher than 1 % even in >20 mm lesions. Intraprocedural bleeding (IPB) can occur at rates as high as 1.77-9.13 % for cold snare polypectomies (CSP). On the other hand, rates of PPB for CSP were only 0-0.3 % ; lower than for other resection methods with coagulation. Rates of perforation were almost zero for CSP. When reviewing the literature attention should be payed to the following points ; if the study was prospective or retrospective, the average size of target lesions, the definition of complication(s) and if the rates were calculated per patient or per lesion.
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