Endoscopic Minimally Invasive Treatment On Colorectal Protruded Polyps And Health Economic Analysis

【Objective】Study the advantage of endoscopic minimally invasive treatment on colorectal protruded polyps.【Methods】The first,From January 2007 to June 2008,258consecutive patients with 337 colorectal protruded polyps were assigned to four groups according to Yamada classification.The resection methods included electrocautery snare resection,endoscopic mucosal resection(EMR),argon plasma coagulation(APC),nylon ligature and combined therapy.Observe the relevance of the Yamada Classification to polyp size,position in the colon,surface characteristics,the distribution of pathologic type,the degree of dysplasia,and endoscopic treatment.The resection validity rate, the resection invalidity rate and hemorrhage rate,perforation rate and recurrence of residual lesions rate will be registered.And logistic regression analyze the leading to the complications of factors.Then compare 21 cases who suffered surgical treatmen,on the retrospective collection from January 2004 to March 2008,with 21 cases from this study on the health economics analysis.Comparing difference in overall effect,total costs,direct costs and indirect costs between the two groups and proceeding to cost - effectiveness analysis(CEA),sensitivity analysis,ineremental analysis and cost-utility analysis(CUA).【results】The polyps size,distribution of pathologic type,surface characteristics and endoscopic treatment and the Yamada Classification correlated(P＜0.01).All of the polyps resected in endoscopy successfully,the resection validity rate was 100%. There was 40 lesion,about 11.9%,bleeding but none of these was perforation, finging residual and recurrent in the fellow-up surveillance afer polypectomy.Group bleeding and difference treatment complication rate difference was not significant (P＞0.05).This set of data in bleeding complications arising from the analysis of relevant factors when no clear risk factors(P＞0.05).On the health economic analysis 42 cases of patients with single colorectal protruded adenomas were complete resection,no recurrence.The total costs,the direct costs and the indirect costs of laparotomy are more than endoscopic minimally invasive treatment,the difference between the two groups were statistical ignificant(P＜0.001).Cost-effectiveness analysis revealed that the mean cost of laparotomy group was 16959.98(8676.18) yuan to restore or extend a life,but the endoscopic minimally invasive treatment group was 172.05(434.02) yuan,the difference between the two groups were statistical significant(P=0.01).Sensitivity analysis indicated that laparotomy group costed more than endoscopic minimally invasive treatment group as increase or decrease the cost of patients individual at 100 yuan,the difference between the two groups were statistical significant(P＜0.05).Incremental analysis showed that 2183.40 yuan which is△C/△E,higher than the cost of endoscopic treatment group to restore a life-year extension.Cost-utility analvsis revealed that the mean cost of laparotomy group was 2324.85(16076.71) yuan more than 183.02(450.76) yuan in endoscopic minimally invasive treatment group to restore or extend a quality adjusted life years, the difference between the two groups were statistical significant(P =0.03).【Conclusions】Minimally invasive endoscopic resection of colon polyps protruded type is safe,reliable and effective.Yamada classification to reflect the colorectal protruded polyps' morphological characteristics that can effectively guide the endoscopic resection.Minimally invasive endoscopic resection of colorectal protruded polyps is more economically than traditional open surgery and patients will have more higher quality of life in the postpolypectomy.In short,minimally invasive endoscopic treatment of colorectal protruded polyps is the preferred method of treatment because of the advantage.