Hijikata Yasutaka, Ogasawara Naotaka, Sasaki Makoto, Mizuno Mari, Masui Ryuta, Kondo Yoshihiro, Izawa Shinya, Ito Yoshitsugi, Noda Hisatsugu, Kasugai Kunio
Department of Gastroenterology, Aichi Medical University School of Medicine, Aichi, Japan.
Hepatogastroenterology. 2012 Mar-Apr;59(114):353-6. doi: 10.5754/hge11458.
BACKGROUND/AIMS: Endoscopic submucosal dissection (ESD) is technically demanding and requires considerable skill. We previously described sheath-assisted counter traction ESD that uses simple materials and methods to improve cutting line visualization. We recently improved counter-traction of the submucosal layer using a novel chemically treated sheath that reduces slippage and maintains traction, and investigated the utility of the novel sheath for ESD.
Forty-three and 25 consecutive patients with early gastric carcinomas were treated by standard ESD and traction ESD assisted with novel sheaths, respectively. The mean duration of procedures relative to tumor size and location, as well as complications after ESD between the two groups were compared.
The mean duration of ESD procedures for lesions =20mm in diameter was significantly reduced using the novel sheath. The mean duration of procedures for all locations of resected tumors in the stomach was significantly reduced using the novel sheath. However, no perforation and delayed bleeding developed after treatment with the novel sheath.
Sheath-assisted counter traction ESD by the novel sheath was technically simpler and thus less time-consuming regardless of the location of lesions, especially when =20mm in diameter. The traction ESD with the novel sheath is safe and not invasive, and it can be universally applied to standard ESD.
背景/目的：内镜黏膜下剥离术（ESD）技术要求高，需要相当的技巧。我们之前描述了鞘辅助反向牵引ESD，其使用简单的材料和方法来改善切割线的可视化。我们最近使用一种新型化学处理鞘改进了黏膜下层的反向牵引，该鞘减少了滑动并保持了牵引，并研究了这种新型鞘在ESD中的实用性。
分别对43例和25例连续的早期胃癌患者进行标准ESD和新型鞘辅助牵引ESD治疗。比较两组ESD相对于肿瘤大小和位置的平均手术时间以及ESD后的并发症。
使用新型鞘时，直径≤20mm病变的ESD平均手术时间显著缩短。使用新型鞘时，胃内所有切除肿瘤部位的平均手术时间均显著缩短。然而，使用新型鞘治疗后未发生穿孔和延迟出血。
新型鞘辅助反向牵引ESD技术上更简单，因此无论病变位置如何，尤其是直径≤20mm时，耗时更少。新型鞘牵引ESD安全且无创，可普遍应用于标准ESD。
