Department of Endoscopy, The Jikei University School of Medicine, 3-25-8 Nishi Shinbashi, Minato-ku, Tokyo 105-8461, Japan.
World J Gastroenterol. 2009 Dec 28;15(48):6086-90. doi: 10.3748/wjg.15.6086.
To evaluate the usefulness of a balloon overtube to assist colorectal endoscopic submucosal dissection (ESD) using a gastroscope.
The results of 45 consecutive patients who underwent colorectal ESD were analyzed in a single tertiary endoscopy center. In preoperative evaluation of access to the lesion, difficulties were experienced in the positioning and stabilization of a gastroscope in 15 patients who were thus assigned to the balloon-guided ESD group. A balloon overtube was placed with a gastroscope to provide an endoscopic channel to the lesion in cases with preoperatively identified difficulties related to accessibility. Colorectal ESD was performed following standard procedures. A submucosal fluid bleb was created with hyaluronic acid solution. A circumferential mucosal incision was made to marginate the lesion. The isolated lesion was finally excised from the deeper layers with repetitive electrosurgical dissections with needle knives. The success of colorectal ESD, procedural feasibility, and procedure-related complications were the main outcomes and measurements.
The overall en bloc excision rate of colorectal ESD during this study at our institution was 95.6%. En bloc excision of the lesion was successfully achieved in 13 of the 15 patients (86.7%) in the balloon overtube-guided colorectal ESD group, which was comparable to the results of the standard ESD group with better accessibility to the lesion (30/30, 100%, not statistically significant).
Use of a balloon overtube can improve access to the lesion and facilitate scope manipulation for colorectal ESD.
评估球囊外套管在经胃镜辅助结直肠内镜黏膜下剥离术（ESD）中的应用价值。
在单家三级内镜中心，分析了 45 例行结直肠 ESD 患者的结果。在术前评估到达病变部位时，有 15 名患者在定位和稳定胃镜方面遇到困难，因此将其分配到球囊引导 ESD 组。在术前确定与可及性相关的困难的情况下，将球囊外套管放置在胃镜上，为病变提供内镜通道。采用标准程序进行结直肠 ESD。用透明质酸溶液创建黏膜下液泡。进行环形黏膜切口以边缘化病变。最后，用针状刀进行多次电外科剥离，从较深的层次切除孤立的病变。结直肠 ESD 的成功率、操作可行性和与操作相关的并发症是主要的结果和测量指标。
在本研究中，我院结直肠 ESD 的整块切除率为 95.6%。在球囊外套管引导的结直肠 ESD 组中，15 名患者中的 13 名（86.7%）成功地整块切除了病变，与病变可及性更好的标准 ESD 组（30/30，100%，无统计学意义）的结果相当。
使用球囊外套管可以改善病变的可达性，并有助于结直肠 ESD 中的内镜操作。
