Western medical treatment for gastric polyps
I. Endoscopic treatment
Endoscopic resection is the preferred method for the treatment of gastric polyps, mainly high-frequency electrocoagulation resection method, laser and microwave cauterization method, nylon wire ligation method and argon ion coagulation method, etc. Endoscopic treatment of polyps is simple, less damaging and less expensive, and most of them are one-time treatment, while a few need to be removed in stages. Regular follow-up by endoscopy can also detect the recurrence of polyps, and give timely treatment to prevent cancer.
1.High-frequency electrocoagulation method: It is the most widely used method, and its principle is to use the thermal effect generated by high-frequency current to cause tissue coagulation and necrosis to achieve the purpose of removing polyps. Generally, the current frequency is above 300 kHz, and the output power is 30-80 W. Before surgery, the liquid in the stomach should be aspirated as much as possible, and the electrocoagulant or electrothermal biopsy forceps with a spherical front end should be preferred for polyps less than 0.5 cm. When using the electrothermal biopsy forceps, the head should be bitten and gently lifted before cauterization. For tipped and non-tipped polyps larger than 0.5 cm, the trap should be selected as far as possible, but the spherical electrocoagulator or electrothermal biopsy forceps can also be used to cauterize them in stages.
For tipped polyps, the trap should be placed over the tip and the residual tip should be retained for about 1 cm after electrification to avoid perforation due to deep tissue burn. For non-tipped polyps, hypertonic saline or 1:10,000 epinephrine solution should be injected into the base of the polyp at 1 to 2 points, 1.0 ml per point, to avoid damaging the muscle layer and plasma membrane layer during trap resection, and then the head of the polyp should be lifted with a double biopsy tube endoscope to form a pseudo-tip at its base before trap resection.
The polyps can be treated in stages, i.e. the head of the polyp will be partially removed obliquely with a lap sleeve first, and then the opposite part will be removed obliquely after an interval of 2 weeks, if it is not completely removed, it can be repeated until all the polyps are removed; it can also be treated with a combination of suction and electrocoagulation, i.e. the suction sleeve is placed in front of the endoscope, the lap sleeve for electrocoagulation is placed in the suction sleeve through the biopsy hole, the endoscope is sent to the gastric cavity, and the head end of the suction sleeve is placed in close contact with the polyp. After close contact with the polyp, negative pressure is applied to the polyp until it is all sucked into the sleeve, and then the lancet is tightened and the polyp is withdrawn for electrocoagulation.
For larger tipped or subtip polyps, metal clamps can also be used to ligate the polyp and then perform electrocoagulation by inserting a rotatable clamping device through the endoscopic biopsy hole, and performing multiple crossed metal clamps on the stem of the polyp to block the blood supply to the lesion, and then performing electrocoagulation when the head end of the polyp is purple. When using trap electrocoagulation, we need to pay attention to the slow tightening of the trap loop before energization, and gently lift to avoid bleeding and deep tissue burns caused by mechanical cutting, after tightening the trap loop to first electrocoagulation and then electrocutting, repeatedly alternating, each time the energization time of a few seconds, but also available mixed current intermittent energization treatment.
2, microwave cautery method: the use of microwaves can make polar molecules vibrate to produce the principle of thermal effect, and the tissue coagulation and vaporization for polyp cauterization, and hemostasis, for polyps less than 2cm in diameter, the smaller polyps can be 1 time cauterization, the larger ones require multiple treatments. The output power is 30-40W, and the time of each cautery can be adjusted and fixed before treatment, usually 5-10s, or controlled by a foot switch.
Operation by biopsy mouth inserted microwave coaxial cable (antenna), so that the spherical probe close contact with the lesion, or needle probe into the lesion after cauterization, should pay attention to control the depth of tissue burn, so as not to cause perforation. The method is simple, safe, low cost and easy to carry out.
3, laser method: the laser generated by the high energy laser, through the endoscopic biopsy hole into the optical fiber irradiation lesion site, through the transformation of light energy heat energy, so that its tissue protein coagulation, denaturation and destruction to achieve the purpose of treatment. It is mostly used for the treatment of wide-tipped or non-tipped polyps. At present, Nd:YAG laser is mostly used, and the power can be selected according to the size of polyps, generally ranging from 50 to 70 W. When operating, the head end of the optical fiber is about 1 cm away from the lesion, and each irradiation is 0.5 to 1 s. Excessive time may cause perforation, which should be noted.
Larger polyps can be treated in multiple stages. Alternatively, laser treatment can be used, which is characterized by small damage to the tissue around the lesion and shallow penetration depth. The laser should be directed at the lesion and irradiated quickly to avoid damage to the surrounding tissues by gastric peristalsis.
4.Nylon wire and rubber band ligation method: By ligating the root of polyps, it causes ischemic necrosis to achieve the treatment purpose. Pathology confirmed that after treatment, the ligature site muscle layer is intact and only confined to the mucosa and submucosa to produce local ischemic necrosis. Within 1-4 days after ligation, an acute inflammatory reaction occurs in the local mucosa, and the granulation tissue proliferates and necrotic tissue is shed to form a superficial ulcer, which is gradually replaced by scar tissue and heals, so it has the advantage of avoiding perforation.
Method: A clear suction sleeve is placed at the front of the endoscope. The ligature is fed into the biopsy hole and probed from the front end, the nylon ligature sleeve or rubber band is placed in the groove of the sleeve, the endoscope is sent to the gastric cavity, the head end of the sleeve is in close contact with the polyp, the polyp is drawn into the sleeve by negative pressure, the handle of the ligature is pulled, and the nylon wire or skin band is ligated to the root of the polyp. The polyps fall off and form shallow ulcers within the first week after ligation, and heal with white scar formation in the third to fourth week.
5.Argon ion coagulation: Argon gas can conduct high-frequency electrical energy generated by tungsten wire electrode through ionization to make tissue coagulation effect, which has been applied to endoscopic treatment in recent years and received better efficacy. It is mainly applied to wide base without tip and the diameter is less than 1.5cm. Insert the argon ion coagulator catheter through the endoscopic biopsy hole, make the head end of the catheter 0.3~0.5cm above the lesion, start the foot switch for argon ion coagulation treatment, 1~3s each time.
6.Freezing method: The refrigerating gas is sprayed directly on the polyp surface through the endoscopic biopsy hole by a special catheter, or the lesion is frozen by contact with a special freezing rod to make the tissue necrotic and fall off. Therefore, it is difficult to cure a single large polyp in 1 time, so it is rarely used.
7, radiofrequency method: radiofrequency for a 200 ~ 750kHz electromagnetic wave, into the lesion tissue, local heat generation to evaporate water, dry and necrosis to achieve the purpose of treatment. Operation control RF treatment instrument output power of 23 ~ 25W, working time of 5 ~ 10s, the electrode through the endoscopic biopsy hole into the lesion for treatment.
8.Alcohol injection method: endoscopically inject anhydrous alcohol around the base of the polyp in a circle as a dot injection, 0.5ml per dot, and see the white mound elevation as degree. Generally, it is only used for the treatment of broad-based polyps.
Second, anti-Hp treatment
Recent studies have shown that Helicobacter pylori (Hp) infection is closely related to the occurrence of hyperplastic polyps, and Hp-positive hyperplastic polyps are successfully eradicated after Hp infection, and the polyps completely regressed in about 40% of the cases. Therefore, Hp test should be performed for the diagnosis and treatment of hyperplastic polyps, and if positive, Hp eradication therapy should be performed, and then the polyps should be treated accordingly according to the regression of polyps.
Third, surgical treatment
The indications for surgery are
1.Non-tip or broad-based polyps larger than 2cm.
2.Polyps with progressive enlargement.
3.Adenomatous polyps with heterogeneous hyperplasia, suspicious cancer and carcinoma on pathological examination.
Chinese medicine treatment for gastric polyp
There is no relevant treatment for the current disease.
IV. Prognosis
Gastric polyps are generally benign and do not require treatment if they are asymptomatic. Hyperplastic polyps are non-neoplastic polyps, because no malignant lesions will occur, and the effect is better with symptomatic treatment by internal medicine. Adenomatous polyps can have a cancer rate of 30% to 58.3%, and should be treated surgically if the diagnosis is confirmed by biopsy.