The Pathologic Differences Between Clamping Biopsy And Postoperative Resection After EMR And ESD In Colorectal Adenoma

Objectives:With the increasingly westernized dietary structure of Chinese residents and the aging of society,the incidence and mortality of colorectal cancer have increased.In the 21 st century,colorectal cancer has become an important factor affecting health and colorectal polyps are the precursor disease of most colorectal cancer(CRC).Through retrospectively analyze the relationship between biopsy pathology of colorectal adenomatous polyps and endoscopic submucosal dissection(ESD)or endoscopic mucosal resection(ESD)to explore the risk factors of pathological upgrading between endoscopic biopsy forceps pathology and resection pathology of colorectal polyps,and to provide some help for practical clinical work.Methods:64 patients who underwent colonoscopy at the Digestive Endoscopy Center of the Fourth Affiliated Hospital of Nanchang University from January 2020 to January2023,and were found to have polyps with diameter ≥1cm and biopsy suggested tubular adenoma and then underwent EMR or ESD in our hospital were collected as the subjects of this experimental study.The pathology of the same polyp biopsy clamp was compared with the pathology after EMR and ESD.According to the pathological comparison results,the patients with pathological escalation after EMR and ESD were divided into pathological escalation group,and the patients with the same pathology after EMR and ESD and biopsy were divided into pathological consistent group.By comparing the general characteristics of the two groups of patients,such as age and gender;Endoscopic characteristics,such as polyp size,polyp location,polyp morphology,and whether the polyp surface was red or erosive,were analyzed by univariate analysis,and then the different characteristics were included in the multivariate Logistic regression analysis to explore the risk factors causing pathological upgrading and provide some help for clinical practice.Results:(1)There were differences in the pathological results of the same polyp between preoperative biopsy and EMR or ESD,and 53 cases were consistent,accounting for82.81%(53/64).There were 8 cases of pathological upgrading,accounting for 12.5%(8/64).(2)Univariate analysis showed that there was no significant difference in the distribution of age and gender between the two groups(P > 0.05).There was no significant difference in the distribution of polyp location between the two groups(P > 0.05).There was no significant difference in the surface congestion or erosion of polyps between the two groups(P > 0.05).There were significant differences in polyp diameter and polyp morphology between the two groups(P < 0.05).(3)Polyp diameter and polyp morphology were included to construct a multivariate logistic regression equation.Pathological escalation was used as a dependent variable(y:1= occurrence of pathological escalation,0= pathological consistency).The effect of polyp diameter on pathological escalation was statistically significant(P =0.003,OR=15,025).The larger the polyp diameter was,the higher the risk of pathological escalation was.Conclusions:(1)The coincidence rate of advance colorectal adenomatous polyps biopsy and EMR,ESD postoperative pathological diagnosis was 82.81%.(2)The diameter of polyps ≥2cm is a risk factor for biopsy forceps and pathological escalation after EMR and ESD.Clinicians should pay attention to the postoperative pathological results of polyps with diameter ≥2cm when biopsy forceps.