TEHNIKE ENDOSKOPSKE MUKOZNE RESEKCIJE KOLOREKTALNIH POLIPA

Olga Mandić

doi:10.5937/mp75-43751

Olga Mandić KBC "Bežanijska kosa", odeljenje gastroenterohepatologije

DOI: https://doi.org/10.5937/mp75-43751

Ključne reči: Kolorektalni polipi, optička dijagnoza, tehnike endoskopske mukozne resekcije, postproceduralno krvarenje i perforacija

Sažetak

Endoskopska mukozna resekcija (EMR) je terapijska tehnika koja je razvijena za resekciju sesilnih i ravnih lezija lokalizovanih u području mukoze bilo kojeg dela gastrointestinalnog trakta (GIT). Jedna od glavnih prednosti ove tehnike je što dozvoljava resekciju velikih polipa koji bi inače zahtevali radikalnu operaciju. U svrhu rane detekcije neoplazija GIT-a najbolje se pokazao skrining program za kolorektalni karcinom, a njegovo široko prihvatanje dovelo je do smanjivanja stope incidencije i mortaliteta. Ovaj rad daje pregled EMR tehnika i fokusira se na velike kolorektalne polipe, koji predstavljaju najčešću indikaciju za EMR. Pre nego što započne resekciju, endoskopista treba pažljivo i detaljno da pregleda leziju i napravi razliku između resektabilne lezije od onih koje su potencijalno zahvaćene submukoznom invazijom. Postoje različite metode procene polipa, zahvaljujući naprednim tehnikama. Karakteristike kolorektalnih lezija, uključujući lokalizaciju, veličinu, morfologiju i histologiju, utiču na izbor optimalne metode uklanjanja. EMR-om se odstranjuje deo zida kolorektuma koji sadrži mukozu, muscularis mukozu i delimično ili kompletno, submukozni sloj. Pored uklanjanja benignih adenoma različitog stepena atipije, mukozektomija omogućava lečenje ranog kolorektalnog karcinoma gde je rizik od metastaza u limfne žlezde minimalan. Primarni cilj EMR je potpuno i bezbedno uklanjanje kolorektalne lezije i potpuna prevencija kolorektalnog karcinoma. Tehnike za izvođenje EMR-a podrazumevaju konvencionalnu EMR sa submukoznim ubrizgavanjem rastvora u kolorektalnu leziju i sledstveno odrstranjivanje promene vrućom omčom (elektrohirurškim kauterom), kao i alternativne EMR tehnike, kao što su EMR sa hladnom omčom i EMR ”pod vodom”. Glavni neželjeni događaji povezani sa EMR-om su krvarenje i perforacija nakon mukozektomije. Zbog rizika od recidiva polipa bez obzira na tehniku EMR-a, kao i rizika od nastanka metahronih polipa neophodne su kontrolne kolonoskopije, naročito kod pacijenata sa povećanim rizikom od nastanka recidiva.

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