Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Gastrointest Endosc. 2011 Oct;74(4):906-11. doi: 10.1016/j.gie.2011.05.030. Epub 2011 Jul 29.
Endoscopic submucosal dissection (ESD) is increasingly used for en bloc removal of GI lesions. Current ESD techniques have limitations including long procedure times, technical difficulty, and complications.
To compare mesna with saline solution for ESD.
Blinded, randomized, controlled, porcine study in live animals.
Animal laboratory.
Twelve gastric lesions were marked by using electrocautery. After submucosal injection, a circumferential mucosal incision was created, and ESD was performed by using a flexible Maryland dissector. Half of the ESDs were performed with submucosal injection of mesna.
Primary outcome was the time to dissect the submucosal plane. Secondary outcomes were total ESD time, specimen size, and procedure related complications.
The average (± SD) time for dissecting the submucosal plane was 15 minutes (range 10-22 ± 4.8 min) in the group with submucosal mesna injection and 16 minutes (range 8-29 ± 8.3 min) in the control group (P = 1.0). Complete en bloc resection including all of the electrocautery markings was achieved in all cases. Injection of mesna did not provide any benefit over saline solution in terms of overall ESD time (24 ± 7.3 min vs 28 ± 11 min; P = .42). There were no perforations. Four hemorrhages requiring intervention were encountered during the procedures in the control group, compared with no bleeding in the mesna group (P = .09).
Animal model, limited sample size.
Submucosal mesna injection did not affect procedure times but was associated with a trend toward a lower incidence of intraprocedural bleeding.
内镜黏膜下剥离术（ESD）越来越多地用于整块切除胃肠道病变。目前的 ESD 技术存在局限性，包括手术时间长、技术难度大以及并发症多等。
比较美司钠与生理盐水用于 ESD。
在活体动物中进行的盲法、随机、对照的猪研究。
动物实验室。
使用电烙标记 12 个胃病变。黏膜下注射后，进行环形黏膜切口，使用柔性 Maryland 剥离器进行 ESD。ESD 的一半采用美司钠黏膜下注射。
主要结局指标是分离黏膜下层平面的时间。次要结局指标包括总 ESD 时间、标本大小和与操作相关的并发症。
美司钠黏膜下注射组分离黏膜下层平面的平均（±SD）时间为 15 分钟（范围 10-22 ± 4.8 分钟），对照组为 16 分钟（范围 8-29 ± 8.3 分钟）（P=1.0）。所有病例均实现了完整的整块切除，包括所有电烙标记。与生理盐水相比，美司钠注射在总 ESD 时间方面没有任何优势（24 ± 7.3 分钟与 28 ± 11 分钟；P=0.42）。没有穿孔。对照组在手术过程中出现了 4 例需要干预的出血，而美司钠组没有出血（P=0.09）。
动物模型，样本量有限。
黏膜下层美司钠注射并不影响手术时间，但与术中出血发生率降低趋势相关。
