Chen Peng-Jen, Huang Wen-Chien, Wang Hsiu-Po, Chang Wei-Kuo, Hsieh Tsai-Yuan, Shih Shou-Chuan, Wang Horng-Yuan, Liu Chia-Yuan
Division of Gastroenterology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Scand J Gastroenterol. 2012 Nov;47(11):1386-93. doi: 10.3109/00365521.2012.725091. Epub 2012 Sep 19.
Endoscopic submucosal dissection (ESD) is a technically difficult, hazardous, and time-consuming treatment option for superficial neoplasms of the esophagus. The aim of this pilot study was to determine the effectiveness and safety of percutaneous transgastric traction (PTT)-assisted ESD, a method that overcomes the drawbacks of conventional ESD, in a porcine model.
Six domestic pigs (25-30 kg) were used in the study. In each animal, two 5-cm-long esophageal areas were assigned randomly for resection by conventional ESD or PTT-assisted ESD. The PTT method was designed to offer esophageal mucosal traction directed toward the stomach. The wire was introduced into the stomach through a percutaneous transgastric cannula and was fixed on the resected esophageal mucosa.
Submucosal dissection in the traction group required only half the time of that in the non-traction group (mean dissection time 596.0 vs. 1127.3 s, respectively; p = 0.01). At necropsy, no differences in the incidence of perforation or bleeding were found between two groups.
The PTT method can enhance the speed of submucosal dissection for esophageal ESD to completely remove large areas of resected mucosa.
内镜黏膜下剥离术（ESD）是治疗食管浅表肿瘤的一种技术难度大、风险高且耗时的治疗方法。本初步研究的目的是在猪模型中确定经皮经胃牵引（PTT）辅助ESD的有效性和安全性，该方法克服了传统ESD的缺点。
本研究使用了6头家猪（25 - 30千克）。在每只动物身上，随机分配两个5厘米长的食管区域，分别通过传统ESD或PTT辅助ESD进行切除。PTT方法旨在提供朝向胃的食管黏膜牵引。通过经皮经胃套管将金属丝引入胃内，并固定在切除的食管黏膜上。
牵引组的黏膜下剥离时间仅为非牵引组的一半（平均剥离时间分别为596.0秒和1127.3秒；p = 0.01）。尸检时，两组之间穿孔或出血的发生率没有差异。
PTT方法可以提高食管ESD黏膜下剥离的速度，以完全切除大面积的切除黏膜。
