| ObjectiveTo evaluate whether the SMSA grading tool correlates with endoscopic and clinical outcomes of colonic polyps.Methods: Retrospectively analyzed the result of endoscopic and clinical outcomes of sessile colonic polyps which is identified in a singal center and treated with EMR or ESD from January 2016 to October 2010.All polyps were included in this study is classified as per the SMSA grading system.Result1.281 polyps found in 281 patients were included,of these,192 cases were male,89 cases were female,with a mean age of 58.4±11.7(20–86)years.The main clinical symptoms were abdominal pain(61.6%),including 74 cases of abdominal pain,64 cases of diarrhea with abdominal pain,35 cases of abdominal pain with abdominal distension.In addition,There were 22 cases of hematochezia or melena,18 cases of constipation,16 cases of postoprative.7 cases of stool shape change,4 cases of diarrhea,alternate constipation,2 cases of wasting and fatigue,and 39 cases of colonic polyps were found in routine examination.There was no significant difference in age,sex and coagulation index of polyp according to SMSA grade(P > 0.05).2.Among all lesions,Most(96.2%)were smaller than 30 mm,with 2.1% measuring 30–39 mm,and only 1.8% being larger than 40 mm.84.0% were sessile,9.5% were pedunculated,and 7.5% were NPL.In 6% of cases,access to the lesion was considered difficult.The majority of the lesions(63.6%)were located in the left colon,36.7% in the right colon.The neoplastic lesions were reclassified according to the SMSA score.124 colorectal lesions were level 1(44.1%),133 level2(47.3%),18 level 3(6.4%)and 6 level 4(2.1%).Comparing the clinical characteristics of each group,we can see that there are differences in size,shape,location and accessibility among groups,and the difference is statistically significant(P< 0.05).3.The rate of complete resection at first attempt is 99.3%,and no residual after coagulation.In 45.2% of cases it was necessary to resort to additional therapeutic procedures such as coagulation by Argon Plasma or snare tip or even the application of metal clips to achieve haemostasis.Overall prevalence of complications was 4.9%(14 cases),of which 6 bleeds(2.1% of the total),and 8 postpolypectomy syndromes(2.8%).no perforations.All complications were ret-rospectively graded as per ASGE classification,with 13 being mild and 1 moderate.no one was referred to surgery.4.A non-neoplastic lesion was diagnosed in 39 cases(13.9%)whereas neoplasia was found in 242 instances(86.1%).Of these,21.0% were tubular adenomas,6.8% villioustublar adenoma,45.9% were adenomas with low-grade dysplasia,10.7% adenomas with high-grade dysplasia,,4 lesions(1.4%)removed did not fall into any of the above histological categories and were represented by leiomyomas and granulation tissue.5.There is a linear increase infrequency of measured outcomes with increasing level of SMSA score.We also analysed the frequency distribution of the same events in relation to the sole size(and no longer to the SMSA score).Despite distribution of frequencies being statistically significant,the linearity of that relationship disappears.In fact,for these variables,outcome measures appear to present a low overall frequencyof events for sizes smaller than 10 mm and a higher rate for lesions> 10 mm.No clear linear relationship between the size and the out-come measures is demonstrated.6.The binary Logistic regression model was used to examine the predictive ability of SMSA score and size to the selected outcome measures.It can be seen that with the increase of SMSA score,the prediction ability of outcome index shows a linear increasing trend,while the prediction ability of size to outcome index is generally smaller than that of SMSA score,and although the predictive ability of extra-procedural treatment still has an increasing trend.However,the linear relationship between complications and late histologic results disappeared.This indicates that SMSA score can be an important predictor of the main postoperative complications.For patients with high grade,they should be operated carefully during operation,and more observation and further histology examination are needed after operation.Conclusions1.The occurrence and development of sessile colorectal polyps is hidden and there may be no obvious symptoms in the early stage.Colonoscopy screening should be carried out in the high risk population at an early stage.2.EMR and ESD are safe methods for the treatment of sessile colorectal polyps.Although there is a certain risk of complications,most of them are within the controllable range.3.SMSA score is a simple and easy to apply clinical scoring system,which can predict the complexity of complete resection of colorectal polyps without pedicle under endoscope,the main postoperative complications and the risk of late histology. |
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