导读：
在治疗>20mm的大型结直肠肿瘤方面，EMR和ESD的成本效益如何？EMR后进行辅助热消融是否可以降低肿瘤的复发率呢？在对复发性肿瘤进行内镜下瘢痕评估时，什么时候必须要进行活检呢？本期《柳叶新潮》从消化内科权威杂志Gastroenterology（IF：19.233）和GUT（IF：17.943）上精选了三篇研究摘要，研究的第一作者分别来自悉尼大学的教学医院Westmead Hospital和梅奥诊所。希望本专题能为各位读者带来启发。
Wide-Field Endoscopic Mucosal Resection Versus Endoscopic Submucosal Dissection for Laterally Spreading Colorectal Lesions: A Cost-Effectiveness Analysis
侧向发育型结直肠病变的大面积内镜下黏膜切除术VS内镜黏膜下剥离术：一项成本效益分析
Farzan F Bahin1, Steven J Heitman1, Khalid N Rasouli1, Hema Mahajan, Duncan McLeod, Eric Y T Lee, Stephen J Williams, Michael J Bourke
GUT; Published time: .10.8
DOI: /10.1136/gutjnl--313823
作者机构：1. Westmead Hospital, Sydney
Objective目的
To compare the cost-effectiveness of endoscopic submucosal dissection (ESD) and wide-field endoscopic mucosal resection (WF-EMR) for removing large sessile and laterally spreading colorectal lesions (LSLs) >20 mm.
在切除>20mm的大型无蒂侧向发育型结直肠病变（LSL）方面，比较内镜黏膜下剥离术（ESD）和大面积内镜下黏膜切除术（WF-EMR）的成本效益。
Design设计
An incremental cost-effectiveness analysis using a decision tree model was performed over an 18-month time horizon. The following strategies were compared: WF-EMR, universal ESD (U-ESD) and selective ESD (S-ESD) for lesions highly suspicious for containing submucosal invasive cancer (SMIC), with WF-EMR used for the remainder. Data from a large Western cohort and the literature were used to inform the model. Effectiveness was defined as the number of surgeries avoided per 1000 cases. Incremental costs per surgery avoided are presented. Sensitivity and scenario analyses were performed.
利用决策树模型进行为期18个月的增量成本效益分析。进行比较的治疗策略有以下三种：1）WF-EMR；2）通用性ESD（U-ESD）：对所有病变都进行ESD；3）选择性ESD（S-ESD）：对高度怀疑为黏膜下浸润性癌（SMIC）的病变进行ESD，对其他病变进行WF-EMR。模型分析的数据来自一项大型西方队列研究和众多文献。有效性指每1000例中避免的手术数量。研究展示每例被避免的手术的增量成本并进行敏感性和情景分析。
Results结果
1723 lesions among 1765 patients were analysed. The prevalence of SMIC and low-risk-SMIC was 8.2% and 3.1%, respectively. Endoscopic lesion assessment for SMIC had a sensitivity and specificity of 34.9% and 98.4%, respectively. S-ESD was the least expensive strategy and was also more effective than WF-EMR by preventing 19 additional surgeries per 1000 cases. 43 ESD procedures would be required in an S-ESD strategy. U-ESD would prevent another 13 surgeries compared with S-ESD, at an incremental cost per surgery avoided of US$210 112. U-ESD was only cost-effective among higher risk rectal lesions.
分析了1765例患者的1723个病变。SMIC和低危SMIC的患病率分别为8.2%和3.1%。SMIC的内镜下病变评估的敏感性和特异性分别为34.9%和98.4%。S-ESD的价格最低，每1000例中可避免进行19例额外手术，有效性高于WF-EMR。在S-ESD策略中，需要进行的ESD数量为43例。与S-ESD相比，U-ESD可以多避免13例手术，避免的每例手术的增量成本为210112美元。U-ESD仅在高危直肠病变中具有成本效益。
Conclusion结论
S-ESD is the preferred treatment strategy. However, only 43 ESDs are required per 1000 LSLs. U-ESD cannot be justified beyond high-risk rectal lesions. WF-EMR remains an effective and safe treatment option for most LSLs.
S-ESD是首选的治疗策略，但是，每1000个LSL中只有43个需要进行ESD。U-ESD仅在高危直肠病变中具有成本效益。对于大多数LSL，WF-EMR仍然是一种有效且安全的治疗选择。
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研究仅供学习分享，不代表《柳叶新潮》观点。
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【学术分享】侧向发育型结直肠病变的大面积内镜下黏膜切除术VS内镜黏膜下剥离术：一项成本效益分析
