OBJECTIVE
To conduct a comparative analysis of the results of treatment of gastric polyps using loop electroexcision, laser EP and EP with aspiration capture.
MATERIAL AND METHODS
In the period from 2018 to 2022, we performed 126 polypectomies, performed in the endoscopic departments of hospitals of the clinical bases of the Department of Surgical Diseases No. 2 of Kursk State Medical University. The average age of the patients was 56±8.6 years, of which there were 106 (84.1%) women and 20 men (15.9%). Depending on the method of polypectomy, patients were divided into the following groups: 94 patients underwent endoscopic polypectomy using an electrocoagulation endoscopic loop, 18 patients received polypectomy using a laser, 14 patients received our proposed method of EP with aspiration capture (RF patent No. 2731886, 2020). Statistical analysis was carried out using the Statistica 10.0 program.
RESULTS
In all groups of operated patients, patients with single (73%) polyps of the antral part of the stomach predominated (76.9%). In most cases, the polyp sizes ranged >10 mm (53.2%), type Ip/Isp (92.1%) according to the Paris classification (2002). Concomitant diseases of the stomach and duodenum were: chronic gastroduodenitis (62.7%), duodenogastric reflux (55.6%), chronic atrophic gastritis (76.2%), and in 108 (85.7%) there was a combination of several diseases. In 45 (35.7%) patients, the test for the presence of Helicobacter pylori was positive. We also found a relationship between HP infection and the development of type Is hyperplastic polyp (OR=1.70, 95%CI 1.12—2.59, P=0.01) and duodenogastric reflux with low HP contamination (OR=1.60, 95%CI 1.05—2.44, P=0.028). All patients underwent FGDS within 6 to 12 months after EP. No polyp recurrence was detected at the removal site, 12 patients were diagnosed with developing hyperplastic polyps of a new localization. It should be noted that these patients refused treatment by a gastroenterologist and the presence of endoscopic signs of concomitant diseases of the stomach and duodenum persisted.
CONCLUSION
All EP methods are competitive, statistically significant differences in the development of intra- and postoperative complications, we did not find any cases of recurrence at the polyp removal site. The choice of the method of endoscopic polypectomy for gastric polyps depends on the material and technical base of the department. Gastric polyps are formed against the background of an already altered gastric mucosa. In the case of hyperplastic polyps, eradication therapy should be carried out at the first stage, after which polyps larger than 1 cm are subject to removal; without preliminary treatment, polyps of the fundic glands larger than 1 cm and tubular adenomas, regardless of their size, are subject to removal. After using any of the methods of endoscopic polypectomy, we recommend referring patients for treatment of concomitant diseases to a gastroenterologist.
