Investigate The Differences And Characteristics Of Different Endoscopic Treatments For Lateral Developmental Tumors Of The Large Intestine

Objective(s):The purpose of this paper is to investigate the differences and characteristics of different endoscopic treatments for lateral developmental tumors of the large intestine.Methods:Retrospective analysis in January 2015 to December 2018 in the Fourth Affiliated Hospital of Kunming Medical University digestive endoscopy center line colonoscopy examination revealed and confirmed the diameter of 10 mm LST of 99 patients(53 cases of rectum and 46 cases of colon)of clinically relevant data,according to the size of the lesion to select different endoscopic treatment,analysis of indicators and prognosis indicators related to the operation,safety and effectiveness.The relationship between lesion size,endoscopic classification and pathological data was also analyzed.The lesion size was subdivided into 20mm,20-40mm and>40mm.Surgical methods:EMR,EPMR and ESD were selected in this paper.Prognostic indicators include cure rate and recurrence rate.All patients were reexamined at least once within 1 year after surgery to observe the recurrence and long-term efficacy.The main types under endoscope were LST-GM,GH,FE and PD.Pathological data included histopathological types(tubular adenoma,villous adenoma,villous-tubular adenoma,serrated adenoma)and cellular atypia(LGIN,HGIN,invasive carcinoma).Results:1.Intraoperative index analysis of different endoscopic surgical methods for lesion>20mm.There was no significant difference in bleeding and perforation between the three different surgical methods(P>0.05).There was a statistically significant difference in the whole block R0 resection rate,P<0.001(P<0.05).2.Comparison of lesion size and endoscopic treatmentThe mean lesion size of EMR group was(21.2±5.8mm),the mean lesion size of ESD group was(39.1±10.5mm),and the mean lesion size of EPMR group was(33.6±9.3mm).The differences among the three groups were statistically significant(P<0.001,P<0.05).The difference in lesion size between the EMR group and the ESD group was statistically significant(P<0.001,P<0.05).The difference in lesion size between the EMR group and the EPMR group was statistically significant(P<0.001,P<0.05).There was no significant difference in lesion size between the ESD group and the EPMR group(P=0.191,P>0.05).3.Comparison of operative time and endoscopic treatmentThe operative time was(33.20±21.74min)in the EMR group,(58.61±26.99min)in the ESD group,and(45.94±16.10min)in the EPMR group,with statistically significant differences among the three groups(P<0.001,P<0.05).The difference in operation time between the EMR group and the ESD group was statistically significant(P<0.001,P<0.05).There was no significant difference in operation time between EMR group and EPMR group,ESD group and EPMR group(P>0.05).4.Observed postoperative indicators of different endoscopic surgical methods for the lesion with>20mmThere was no local recurrence in EMR treatment,and the cure rate was 100%;3 patients with EPMR had recurrence,the cure rate was 80%;1 patient with ESD recurrence,the cure rate was 96.7%.Postoperative indicators of the three surgical methods were observed and statistically analyzed,and the difference was not statistically significant(P=0.075,P>0.05).5.Analyzed the clinical features of the rectum and colon LSTThe patients with rectal LST were 64.82 11.27 years old,and the patients with colon LST were 64.74 9.61 years old.Colorectal LST was analyzed in terms of age and gender,P>0.05,and the difference was not statistically significant(P>0.05).There was no statistically significant difference between different subtypes at the site of onset.LST-GM and LST-GH were more common in the rectum,and LST-PD was more common in the colon.In the LST,the most ductal adenoma(25/49,51%)and the least serrated adenoma(3/49,6.1%)were found in the rectum.LST-GM showed the most histological types of tubular adenoma.The difference of LST-GM in histological type was statistically significant(P=0.018,P<0.05).LGIN was slightly more than HGIN,and LST-GM was more common in HGIN,while LST-GH was more common in LGIN.The LST lesion was most common at 20mm,>40mm and LST-GM.6.Clinical features of the rectal LST subtypeIn the LST,the most ductal adenoma(25/49,51%)and the least serrated adenoma(3/49,6.1%)were found in the rectum.LST-GM showed the most histological types of tubular adenoma.LST-GM was significant in histological type(P=0.018,P<0.05).LGIN was slightly more than HGIN(19 cases and 18 cases),and LST-GM was more common in HGIN,while LST-GH was more common in LGIN.The-most cases of LST lesion were 20mm(24 cases),>40mm(5 cases),and LST-GM(1 case).7.Clinical features of the LST subtype of the colonThe LST type of the colon was more than the other three types.LST-GM was dominated by tubular adenoma,and LST-GH was mostly villous-tubular,but the difference between different histological types was not statistically significant(P>0.05).The LST cells were mostly LGIN cells,and the difference was statistically significant(P=0.009,P<0.05).The most common lesions were 20-40mm in diameter.8.Relationship between lesion size and cellular atypiaLGIN is the most common in this study.When the lesion>was 20mm,the proportion of LGIN,HGIN and submucosal infiltration was significantly higher than that of the lesion 20mm,but the difference was not statistically significant(P=0.491)(P>0.05).Conclusion(s):1.EMR has a certain safety and efficacy in the treatment of LST with smaller lesions,and it is widely used in clinic.EPMR technology is simple,the incidence of complications is low,the operation time is short,can be used as the focus of 20-40mm treatment.However,when the lesion>was 40mm,ESD treatment could be adopted to reduce the recurrence rate.2.LST was more common in the rectum.Most rectum,colon and LST were lower than LGIN.The LST-GM of the tubuloadenoma below 20mm was predominant in the rectum,and the LST-GM of the tubuloadenoma below 20mm was mostly in the colon.3.The ratio of LST-GM HGIN in rectum was higher than that in colon.The LST ratio increased with the diameter of the lesion.With the increase of lesion diameter,the number of lesions decreased gradually.