Department of Gastroenterology and Neurology, Kagawa Medical University School of Medicine, Kagawa, Japan.
J Gastroenterol Hepatol. 2012 Jan;27(1):81-5. doi: 10.1111/j.1440-1746.2011.06833.x.
Endoscopic submucosal dissection (ESD) enables complete, collective removal of gastrointestinal (GI) malignant tumors, but requires a long operation time. Air insufflated during ESD is distributed throughout the entire GI tract, and thus causes an enlarged feeling of the abdomen. We aimed to reduce the incidence of an enlarged feeling of the abdomen by wedging a balloon in the bulbus duodeni to reduce air flow into the lower parts of the GI tract.
Sixteen patients who were approved by the institutional ethics committee and provided consent to participate in this single-center, prospective study were divided into two groups using a sealed-envelope randomization method: ESD with a balloon wedged in the bulbus duodeni (the balloon [+] group) or conventional ESD with no balloon (the balloon [-] group). Total air volume in the entire GI tract and its change before and after ESD were measured objectively by 3-D computed tomography.
In the balloon (+) group, the mean intestinal gas volume (± standard deviation) was 274.3 ± 142.0 mL before ESD, and 352.5 ± 183.2 mL after, with a mean change of 78.1 ± 139.7 mL. The increase in intestinal gas volume was well controlled. No postoperative complications, such as an enlarged feeling of the abdomen, was reported in the balloon (+) group.
Our new technique has several advantages, including reduction in the frequency of postoperative abdominal symptoms, and will be useful and safe for gastric ESD.
内镜黏膜下剥离术（ESD）可实现胃肠道（GI）恶性肿瘤的整块切除，但需要较长的手术时间。ESD 过程中注入的空气会分布在整个胃肠道内，从而导致腹部膨胀感。我们旨在通过在十二指肠球部塞入一个球囊来减少空气流入胃肠道下部，从而降低腹部膨胀感的发生率。
本单中心前瞻性研究经机构伦理委员会批准，并获得患者同意，采用密封信封随机分组法将 16 例患者分为两组：在十二指肠球部塞入球囊的 ESD（球囊[+]组）或无球囊的常规 ESD（球囊[-]组）。使用三维计算机断层扫描客观测量整个胃肠道中的总气量及其在 ESD 前后的变化。
球囊[+]组患者 ESD 前肠道气体量（平均值±标准差）为 274.3±142.0 mL，ESD 后为 352.5±183.2 mL，平均变化量为 78.1±139.7 mL。肠道气体量的增加得到了很好的控制。球囊[+]组无术后腹胀等并发症发生。
我们的新技术具有减少术后腹部症状发生频率等优点，对于胃 ESD 具有一定的应用价值和安全性。
