SNFGE SNFGE
 
Thématique :
- Endoscopie/Imagerie
Originalité :
Réexamen
Solidité :
Très solide
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Professeur Emmanuel CORON
Coup de coeur :
 
 
Gut
  2016/05  
 
  2016 May;65(5):806-20  
  doi: 10.1136/gutjnl-2014-308481  
 
  Efficacy and safety of endoscopic resection of large colorectal polyps: a systematic review and meta-analysis.  
 
  Hassan C, Repici A, Sharma P, Correale L, Zullo A, Bretthauer M, Senore C, Spada C, Bellisario C, Bhandari P, Rex DK  
  http://www.ncbi.nlm.nih.gov/pubmed/?term=Efficacy+and+safety+of+endoscopic+resection+of+large+colorectal+polyps%3A+a+systematic+review+and+meta-analysis.  
 
 

OBJECTIVE:

To assess the efficacy and safety of endoscopic resection of large colorectal polyps.

DESIGN:

Relevant publications were identified in MEDLINE/EMBASE/Cochrane Central Register for the period 1966-2014. Studies in which ≥20 mm colorectal neoplastic lesions were treated with endoscopic resection were included. Rates of postendoscopic resection surgery due to non-curative resection or adverse events, as well as the rates of complete endoscopic removal, invasive cancer, adverse events, recurrence and mortality, were extracted. Study quality was ascertained according to Newcastle-Ottawa Scale. Forest plot was produced based on random effect models. I(2) statistic was used to describe the variation across studies due to heterogeneity. Meta-regression analysis was also performed.

RESULTS:

50 studies including 6442 patients and 6779 large polyps were included in the analyses. Overall, 503 out of 6442 patients (pooled rate: 8%, 95% CI 7% to 10%, I(2)=78.6%) underwent surgery due to non-curative endoscopic resection, and 31/6442 (pooled rate: 1%, 95% CI 0.7% to 1.4%, I(2)=0%) to adverse events. Invasive cancer at histology, non-curative endoscopic resection, synchronous lesions and recurrence accounted for 58%, 28%, 2.2% and 5.9% of all the surgeries, respectively. Endoscopic perforation occurred in 96/6595 (1.5%, 95% CI 1.2% to 1.7%) polyps, while bleeding in 423/6474 (6.5%, 95% CI 5.9% to 7.1%). Overall, 5334 patients entered in surveillance, 502/5836 (8.6%, 95% CI 7.9% to 9.3%) being lost at follow-up. Endoscopic recurrence was detected in 735/5334 patients (13.8%, 95% CI 12.9% to 14.7%), being an invasive cancer in 14/5334 (0.3%, 95% CI 0.1% to 0.4%). Endoscopic treatment was successful in 664/735 cases (90.3%, 95% CI 88.2% to 92.5%). Mortality related with management of large polyps was reported in 5/6278 cases (0.08%, 95% CI 0.01% to 0.15%).

CONCLUSIONS:

Endoscopic resection of large polyps appeared to be an extremely effective and safe intervention. However, an adequate endoscopic surveillance is necessary for its long-term efficacy.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

 
Question posée
 
La résection endoscopique des gros polypes : sûre et efficace ?
 
Question posée
 
Cette méta-analyse regroupe 50 études et 6442 patients. Elle confirme les excellents résultats de la résection endoscopique des gros polypes, avec un taux de perforation faible (1,5%) et la possibilité, en cas de récidive (14%), d’un re-traitement endoscopique efficace dans 90% des cas. Le risque de survenue d’un cancer au cours de la surveillance est très faible (0,3%).
 
Commentaires

Ces résultats sont à diffuser largement pour favoriser l’adressage des gros polypes à des centres experts réalisant les larges mucosectomies ou la dissection sous-muqueuse.

 
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