Division of Endoscopy and Gastrointestinal Oncology, Shizuoka, Japan.
Dig Endosc. 2012 May;24 Suppl 1:110-6. doi: 10.1111/j.1443-1661.2012.01262.x.
Endoscopic submucosal dissection (ESD) was first applied in the resection of large colorectal tumors 10 years ago. Frequent complications and technical difficulties were serious problems at first, but were gradually improved with experience. Here, we describe the indications, technical aspects and management of complications of ESD for colorectal tumors. In 2009, we introduce the use of small tip insulation-tipped diathermic (IT) knife. Features separating it from the IT knife and IT Knife2 are a smaller ceramic tip and small round disk at the root of the tip. During submucosal dissection, the small tip IT knife could dissect large pieces of tissue intact. This allows us to shorten the procedure time, particularly the submucosal dissection component. A total of 146 ESD for 140 patients were performed between January 2009 and July 2011. En bloc, and en bloc and R0 resection rates were 92.5% and 83.6%, respectively. Median procedural time was 48.5 min for 40.5 mm specimens. Perforation and delayed bleeding occurred in 2.1% and 1.4%, respectively. We successfully performed ESD for colorectal tumors with a shortened procedure time while preserving quality and safety.
内镜黏膜下剥离术（ESD）最初于 10 年前应用于大肠肿瘤的切除。起初，频繁的并发症和技术难度是严重的问题，但随着经验的积累，这些问题逐渐得到改善。在这里，我们描述了大肠肿瘤 ESD 的适应证、技术方面和并发症的处理。2009 年，我们引入了小尖端电切（IT）刀的使用。与 IT 刀和 IT Knife2 相比，它的特点是陶瓷尖端更小，尖端根部有一个小圆盘。在黏膜下剥离过程中，小尖端 IT 刀可以完整地剥离大块组织。这使我们能够缩短手术时间，尤其是黏膜下剥离部分。我们在 2009 年 1 月至 2011 年 7 月期间共对 140 例患者的 146 个大肠肿瘤进行了 ESD。整块切除率和整块及 R0 切除率分别为 92.5%和 83.6%。标本为 40.5mm 时，中位手术时间为 48.5 分钟。穿孔和迟发性出血的发生率分别为 2.1%和 1.4%。我们成功地进行了大肠肿瘤的 ESD，缩短了手术时间，同时保持了质量和安全性。
