Yonezawa J, Kaise M, Sumiyama K, Goda K, Arakawa H, Tajiri H
Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan.
Endoscopy. 2006 Oct;38(10):1011-5. doi: 10.1055/s-2006-944779.
Endoscopic submucosal dissection (ESD) is a new and radical treatment for superficial gastrointestinal neoplasms that provides high rates of en bloc resection compared with treatment by conventional mucosal resection. However, ESD is a complex procedure that is associated with long operating times and a higher complication rate. This feasibility study assessed the use of a novel double-channel therapeutic endoscope for performing en-bloc ESD in order to assess whether the procedure time could be shortened.
The therapeutic endoscope we used (the "R-scope") is equipped with a multibending system and has two movable instrument channels: one moves a grasping forceps vertically for lesion countertraction; the other swings a cutting knife horizontally for dissection. Twenty consecutive patients (18 men, 2 women; mean age 63 years, range 54 - 80 years) with superficial gastric neoplasms in the distal two-thirds of the stomach underwent resection of their tumor by ESD using the R-scope. Forty size- and location-matched gastric neoplasms resected by conventional ESD were reviewed retrospectively for the purposes of comparison.
The rates of curative en-bloc resection, complications, and local recurrence using the two ESD methods were comparable. The mean +/- SD operating time was significantly shorter for ESD using the R-scope than for conventional ESD (57.9 +/- 29.7 minutes vs. 92.8 +/- 58.9 minutes, P = 0.016).
The R-scope appears to shorten the operating time of ESD with comparable efficacy and complication rates.
内镜黏膜下剥离术（ESD）是一种用于治疗浅表性胃肠道肿瘤的全新根治性方法，与传统黏膜切除术相比，其整块切除率更高。然而，ESD是一项复杂的操作，手术时间长且并发症发生率较高。本可行性研究评估了一种新型双通道治疗性内镜在整块ESD中的应用，以判断手术时间是否能够缩短。
我们所使用的治疗性内镜（“R型内镜”）配备了多弯系统，有两个可移动器械通道：一个用于垂直移动抓钳以进行病变对抗牵引；另一个用于水平摆动切割刀以进行剥离。连续20例胃远端三分之二浅表性胃肿瘤患者（18例男性，2例女性；平均年龄63岁，范围54 - 80岁）使用R型内镜通过ESD切除肿瘤。为作比较，回顾性分析了40例采用传统ESD切除的大小和位置匹配的胃肿瘤病例。
两种ESD方法的根治性整块切除率、并发症发生率及局部复发率相当。使用R型内镜进行ESD的平均手术时间（±标准差）显著短于传统ESD（57.9 ± 29.7分钟对92.8 ± 58.9分钟，P = 0.016）。
R型内镜似乎能缩短ESD的手术时间，且疗效和并发症发生率相当。
