Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Asan Digestive Disease Research Institute, no. 388-1 Pungnap-2 dong, Songpa-gu, Seoul, 138-736, Korea.
Surg Endosc. 2013 Apr;27(4):1158-65. doi: 10.1007/s00464-012-2567-y. Epub 2012 Oct 24.
The main problem in performing endoscopic submucosal dissection (ESD) of gastric neoplasms is that it is technically difficult, especially for beginners.
A total of 51 patients were randomly assigned to undergo transnasal endoscope-assisted or routine ESD performed by two endoscopists inexperienced in ESD while supervised by one expert.
Total procedure time (p = 0.330), complete resection rate (p = 0.977), and complication rate (p = 0.157) were similar for the patients who underwent transnasal endoscope-assisted and routine ESD, but bleeding control time was significantly longer in the transnasal endoscope-assisted ESD group (p = 0.002). Three and six patients in the transnasal endoscope-assisted and routine ESD groups, respectively, were "dropped out" during the procedures (p = 0.291). The endoscopists tended to regard the traction with the transnasal endoscope as more useful for large tumors (p = 0.062). Bleeding control in patients who underwent the transnasal endoscope-assisted ESD was significantly longer for patients with tumors located in the anterior wall, posterior wall, and lesser curvature of the stomach (p = 0.001).
Transnasal endoscope-assisted ESD does not result in improved outcomes when performed by beginners, except for some large tumors. The traction method used by beginners was not superior to proper supervision and advice by an expert during ESD and allowing the expert to perform the procedure when the risk of complications is high or the procedure is delayed.
行内镜黏膜下剥离术（ESD）治疗胃肿瘤的主要问题是技术难度大，尤其是初学者。
将 51 例患者随机分为经鼻内镜辅助组和由两位内镜操作经验不足的术者在一位专家指导下行常规 ESD 组。
经鼻内镜辅助 ESD 组与常规 ESD 组的总手术时间（p = 0.330）、完全切除率（p = 0.977）和并发症发生率（p = 0.157）相似，但经鼻内镜辅助 ESD 组的止血控制时间显著延长（p = 0.002）。经鼻内镜辅助 ESD 组和常规 ESD 组各有 3 例和 6 例患者在手术过程中“脱落”（p = 0.291）。术者倾向于认为经鼻内镜牵引对于较大的肿瘤更有用（p = 0.062）。经鼻内镜辅助 ESD 治疗的患者中，肿瘤位于胃前壁、后壁和小弯侧的患者止血控制时间显著延长（p = 0.001）。
初学者行经鼻内镜辅助 ESD 并未改善结局，除了一些较大的肿瘤。初学者使用的牵引方法并不优于专家在 ESD 期间的适当监督和建议，并且在并发症风险较高或手术延迟时允许专家进行操作。
