{"id":4325,"date":"2016-03-28T10:00:28","date_gmt":"2016-03-28T10:00:28","guid":{"rendered":"https:\/\/endoscopiaterapeutica.net\/pt\/uncategorized\/qual-o-melhor-forma-de-resseccao-para-os-polipos-colonicos-subcentimetricos\/"},"modified":"2022-06-17T15:33:34","modified_gmt":"2022-06-17T15:33:34","slug":"qual-o-melhor-forma-de-resseccao-para-os-polipos-colonicos-subcentimetricos","status":"publish","type":"post","link":"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/qual-o-melhor-forma-de-resseccao-para-os-polipos-colonicos-subcentimetricos\/","title":{"rendered":"Qual o melhor forma de ressec\u00e7\u00e3o para os p\u00f3lipos subcentim\u00e9tricos do c\u00f3lon e reto?"},"content":{"rendered":"<p>A polipectomia \u00e9 o procedimento terap\u00eautico endosc\u00f3pico mais comum&nbsp;e todos os colonoscopistas devem estar aptos \u00e0 realizar este procedimento de forma segura e efetiva. A pr\u00e1tica evoluiu consideravelmente nos \u00faltimos anos e atualmente dispomos de v\u00e1rias t\u00e9cnicas e equipamentos para diferentes cen\u00e1rios cl\u00ednicos.<\/p>\n<p>O endoscopista deve considerar o tamanho, caracter\u00edsticas morfol\u00f3gicas e localiza\u00e7\u00e3o do p\u00f3lipo no c\u00f3lon antes de escolher a t\u00e9cnica apropriada. Para p\u00f3lipos pequenos existem v\u00e1rias t\u00e9cnicas que podem ser utilizadas, mas s\u00e3o poucos os estudos dispon\u00edveis para nos guiarem entre qual a mais indicada para cada caso.<\/p>\n<p>Os &nbsp;p\u00f3lipos devem ser divididos entre&nbsp;&nbsp;s\u00e9sseis&nbsp;ou&nbsp;pediculados, e tamb\u00e9m de acordo&nbsp;com o&nbsp; tamanho da les\u00e3o (at\u00e9 3 mm, 3-7 mm e 7-9 mm). Em rela\u00e7\u00e3o \u00e0 localiza\u00e7\u00e3o, a&nbsp;maioria dos estudos considera c\u00f3lon direito do ceco ao \u00e2ngulo espl\u00eanico, e esquerdo os segmentos distais \u00e0 esta regi\u00e3o.<\/p>\n<p>&nbsp;<\/p>\n<h2><strong>P\u00d3LIPOS PEDICULADOS<\/strong><\/h2>\n<ul>\n<li>Melhor tratamento sugerido pela maioria dos estudos e guias \u00e9 a polipectomia com al\u00e7a diat\u00e9rmica, n\u00e3o importando se \u00e9 no c\u00f3lon direito ou esquerdo.<\/li>\n<\/ul>\n<ul>\n<li>P\u00f3lipos com ped\u00edculos maiores do que 1 cm sugere-se o uso de clipe ou <em>endoloop<\/em> para preven\u00e7\u00e3o do sangramento.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h2><strong>P\u00d3LIPOS S\u00c9SSEIS<\/strong><\/h2>\n<p>O tratamento varia de acordo com o tamanho e localiza\u00e7\u00e3o.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Existe um certo consenso no tratamento das seguintes les\u00f5es:<\/strong><\/p>\n<ul>\n<li><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/qual-o-melhor-forma-de-resseccao-para-os-polipos-colonicos-subcentimetricos\/\">P\u00f3lipos s\u00e9sseis<\/a> at\u00e9 3 mm podem ser tratados por pin\u00e7a de bi\u00f3psia fria.<\/li>\n<\/ul>\n<ul>\n<li>Les\u00f5es s\u00e9sseis com 1 cm ou mais, em qualquer lugar do c\u00f3lon, devem ser sempre tratadas por mucosectomia.<\/li>\n<\/ul>\n<ul>\n<li>Les\u00f5es planas ou deprimidas maiores do que 3-4 mm (que n\u00e3o podem ser ressecadas adequadamente por pin\u00e7a fria\/hot\/jumbo) s\u00e3o tratadas por mucosectomia.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h2><strong>Les\u00f5es de tamanho intermedi\u00e1rio <\/strong><\/h2>\n<p>Para as les\u00f5es de 3-7 mm e 7-9 mm&nbsp; as condutas variam bastante.<\/p>\n<p>&nbsp;<\/p>\n<ul>\n<li><strong>Les\u00f5es de 3-7 mm<\/strong>: Boa parte dos estudos considera segura a ressec\u00e7\u00e3o das les\u00f5es de 3-7 mm com al\u00e7a fria. N\u00e3o se recomenda ressec\u00e7\u00e3o com pin\u00e7a de bi\u00f3psia devido \u00e0 alta frequ\u00eancia de ressec\u00e7\u00e3o incompleta. Hot biopsy pode ser usada no c\u00f3lon esquerdo mas \u00e9 contra indicada no c\u00f3lon direito devido ao risco de perfura\u00e7\u00e3o (cada vez menos usada). Al\u00e7a diat\u00e9rmica pode ser usada com relativa seguran\u00e7a no c\u00f3lon esquerdo mas tem um risco de perfura\u00e7\u00e3o maior quando utilizada no c\u00f3lon direito. &nbsp;A mucosectomia se mostra segura, efetiva, com baixo risco de perfura\u00e7\u00e3o e maiores taxas de ressec\u00e7\u00f5es completas destas les\u00f5es.&nbsp; Estudos demonstram que a aplica\u00e7\u00e3o da mucosectomia nas ressec\u00e7\u00f5es de les\u00f5es maiores do que 5 mm no c\u00f3lon direito tem aumentado e \u00e9 sugerida como a melhor op\u00e7\u00e3o por alguns autores.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2016\/03\/pin\u00e7a-les\u00e3o-residual.jpg\" data-rel=\"penci-gallery-image-content\"  rel=\"attachment wp-att-5406\"><img decoding=\"async\" class=\"alignnone size-medium wp-image-5406\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/pinC3A7a-lesC3A3o-residual.jpg\" alt=\"pin\u00e7a les\u00e3o residual\" width=\"300\" height=\"123\"><\/a><\/p>\n<p>(Clique para aumentar) Les\u00e3o plana de 6 mm no ceco. &nbsp;Tentativa de ressec\u00e7\u00e3o com pin\u00e7a de bi\u00f3psia fria. &nbsp;Ap\u00f3s a primeira mordida foi observada les\u00e3o residual com necessidade de ressec\u00e7\u00e3o adicional. Este tipo de tratamento deve ser evitado pois quanto maior o n\u00famero de fragmentos em que a les\u00e3o for ressecada, maior a incid\u00eancia de recidiva.<\/p>\n<p>&nbsp;<\/p>\n<ul>\n<li><strong>Les\u00f5es de 7-9 mm: <\/strong>N\u00e3o se deve usar pin\u00e7a de bi\u00f3psia fria. Hot biopsy \u00e9 contra indicada&nbsp;no c\u00f3lon direito e tem grande taxa de ressec\u00e7\u00e3o incompleta em les\u00f5es maiores do que 5 mm. A al\u00e7a fria \u00e9 uma op\u00e7\u00e3o poss\u00edvel, por\u00e9m, as t\u00e9cnicas mais utilizadas e sugeridas nos artigos para este tipo de les\u00e3o s\u00e3o a ressec\u00e7\u00e3o com al\u00e7a diat\u00e9rmica e a mucosectomia. &nbsp;O uso de terapia t\u00e9rmica (al\u00e7a) sem inje\u00e7\u00e3o submucosa no c\u00f3lon direito tem uma maior incid\u00eancia de perfura\u00e7\u00e3o e s\u00edndrome p\u00f3s polipectomia, levando \u00e0 uma tend\u00eancia em se indicar mucosectomia para estas les\u00f5es quando localizadas nesta regi\u00e3o. No c\u00f3lon esquerdo a ressec\u00e7\u00e3o com al\u00e7a diat\u00e9rmica \u00e9 mais segura do que no c\u00f3lon direito mas a mucosectomia tamb\u00e9m \u00e9 uma op\u00e7\u00e3o que deve&nbsp;ser considerada. Em um estudo multic\u00eantrico prospectivo (6) realizado em 11 institui\u00e7\u00f5es japonesas incluindo 624 pacientes, &nbsp;foi avaliado a aplica\u00e7\u00e3o da mucosectomia em les\u00f5es menores do que 2 cm. &nbsp;O tamanho m\u00e9dio das les\u00f5es era&nbsp;de 8,3 mm <span style=\"text-decoration: underline;\">+<\/span> 3,2 (5-20 mm). A ressec\u00e7\u00e3o em bloco foi obtida em 93,3% dos pacientes com 78,3% de ressec\u00e7\u00f5es completas. A taxa de perfura\u00e7\u00e3o foi &nbsp;0 (zero) e a taxa de sangramento 1,1%. &nbsp; Este estudo demonstra que a mucosectomia \u00e9 uma t\u00e9cnica simples, r\u00e1pida, segura e com altas taxas de ressec\u00e7\u00e3o completa de les\u00f5es menores do que 1 cm.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h2><strong>Como medir as les\u00f5es?<\/strong><\/h2>\n<p>Outra dificuldade na decis\u00e3o terap\u00eautica dos p\u00f3lipos subcentim\u00e9tricos \u00e9 como estimar o tamanho da les\u00e3o. Infelizmente n\u00e3o exite um m\u00e9todo 100% preciso. O tamanho \u00e9 estimado, na maioria das vezes, comparando-se a les\u00e3o com algum dos instrumentos endosc\u00f3picos, geralmente uma pin\u00e7a. Para isso o endoscopista deve conhecer o material que utiliza. A concha da pin\u00e7a de colonoscopia padr\u00e3o mede em torno de 5 mm de comprimento e quando aberta tem aproximadamente 8 mm.<\/p>\n<p>&nbsp;<\/p>\n<p><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2016\/03\/tamanho-da-pin\u00e7a.jpg\" data-rel=\"penci-gallery-image-content\"  rel=\"attachment wp-att-5404\"><img decoding=\"async\" class=\"alignnone size-medium wp-image-5404\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/tamanho-da-pinC3A7a.jpg\" alt=\"tamanho da pin\u00e7a\" width=\"300\" height=\"146\"><\/a><\/p>\n<p>(Clique para aumentar). A) Compara\u00e7\u00e3o da pin\u00e7a aberta (vis\u00e3o endosc\u00f3pica) com \u00e1rea arredondada de 5 mm. B) Medida da pin\u00e7a aberta (aproximadamente 8 mm).<\/p>\n<p>&nbsp;<\/p>\n<p><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2016\/03\/pin\u00e7a-polipo-5-mm.jpg\" data-rel=\"penci-gallery-image-content\"  rel=\"attachment wp-att-5405\"><img decoding=\"async\" class=\"alignnone size-medium wp-image-5405\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/pinC3A7a-polipo-5-mm.jpg\" alt=\"pin\u00e7a polipo 5 mm\" width=\"300\" height=\"122\"><\/a><\/p>\n<p>(Clique para aumentar). A) P\u00f3lipo pequeno&nbsp;no c\u00f3lon descendente. B) Compara\u00e7\u00e3o do p\u00f3lipo com uma das conchas da pin\u00e7a de colonoscopia que mede 5 mm de comprimento.<\/p>\n<p>&nbsp;<\/p>\n<h2><strong>Refer\u00eancias<\/strong><\/h2>\n<ol>\n<li>Riley SA. Colonoscopic polypectomy and endoscopic mucosal resection: A pratical Guide. Britihs Society of Gastroenterology. 2008. Dispon\u00edvel no endere\u00e7o: http:\/\/www.bsg.org.uk\/pdf_word_docs\/polypectomy_08.pdf<\/li>\n<li>Saunders B. \u201cHOW I DO IT\u201d Removing large or sessile colonic polyps.&nbsp;World Endoscopy Organization.&nbsp;Dispon\u00edvel no endere\u00e7o: http:\/\/www.worldendo.org\/assets\/downloads\/pdf\/publications\/how_i_doit\/2007\/omed_hid_removing_large_or_sessile_colonic_polyps.pdf<\/li>\n<li>&nbsp;Lee TJ, Rutter MD, Blanks RG, Moss SM, Goddard AF, Chilton A, Nickerson C,&nbsp;McNally RJ, Patnick J, Rees CJ.Colonoscopy quality measures: experience from the NHS Bowel Cancer Screening&nbsp;Programme.&nbsp;Gut 2012;61:1050e1057. doi:10.1136\/gutjnl-2011-300651<\/li>\n<li>&nbsp;Ross WA, Thirumurthi S, Lynch PM, Rashid A, Pande M, Shafi MA,<br \/>\nLee JH, Raju GS. Detection rates of premalignant polyps during screening colonoscopy: time to<br \/>\nrevise quality standards?&nbsp;GASTROINTESTINAL ENDOSCOPY Volume 81, No. 3 : 2015<\/li>\n<li>&nbsp;Lee TJ, Blanks RG, Rees CJ, Wright KC, Nickerson C, Moss SM, Chilton A,&nbsp;Goddard AF, Patnick J, McNally RJ, Rutter MD. &nbsp;Longer mean colonoscopy withdrawal time is associated with increased adenoma detection: evidence from the Bowel Cancer Screening Programme in England.&nbsp;Endoscopy 2013; 45: 20\u201326<\/li>\n<li>&nbsp;Yoshida N(1), Naito Y, Inada Y, Kugai M, Yagi N, Inoue K, Okuda T, Hasegawa D,&nbsp;Kanemasa K, Kyoichi K, Matsuyama K, Ando T, Takemura T, Shimizu S, Wakabayashi N,&nbsp;Yanagisawa A, Yoshikawa T. Multicenter study of endoscopic mucosal resection using 0.13% hyaluronic acid&nbsp;solution of colorectal polyps less than 20 mm in size.&nbsp;Int J Colorectal Dis (2013) 28:985\u2013991.<\/li>\n<\/ol>\n<p><strong>Confira tamb\u00e9m:<\/strong> <a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/lesoes-sesseis-serrilhadas\/\">Les\u00f5es s\u00e9sseis serrilhadas <\/a><b>| v\u00eddeo sobre: <a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/video\/polipo-pediculado-gastrico-endoloop\/\">Ressec\u00e7\u00e3o de p\u00f3lipo pediculado g\u00e1strico com aux\u00edlio de endoloop<\/a><\/b><\/p>\n","protected":false},"excerpt":{"rendered":"<p>A polipectomia \u00e9 o procedimento terap\u00eautico endosc\u00f3pico mais comum&nbsp;e todos os colonoscopistas devem estar&hellip;<\/p>\n","protected":false},"author":2464,"featured_media":4424,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[151],"tags":[],"ano":[281],"tipo":[156],"volume":[263],"class_list":["post-4325","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-assuntosgerais","ano-281","tipo-colonoscopia","volume-volume-i"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.2 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Qual o melhor forma de ressec\u00e7\u00e3o para os p\u00f3lipos subcentim\u00e9tricos do c\u00f3lon e reto? &#8226; Endoscopia Terapeutica<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" 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