Department of General, Geriatric, Oncological Surgery and Advanced Technology, Special Section of Surgical Digestive Endoscopy, School of Medicine, University of Naples Federico II, Naples, Italy.
Endoscopy. 2013;45(2):121-6. doi: 10.1055/s-0032-1325930. Epub 2013 Jan 10.
Thermal injury of the colonic wall during polypectomy may induce complications such as bleeding and perforation. To date, the role of the snare material in these injuries has not been examined. The aim of this study was to evaluate the depth of colonic post-polypectomy thermal wall injury induced by tungsten and steel endoscopic snares, in an effort to reduce electrosurgery-related complications.
This was a single tertiary center experimental study in a porcine model. A total of 90 polypectomies where performed in three live pigs under general anesthesia, using both steel and tungsten snares by cut, coagulation, and blend current modes. The pigs were then euthanized and their colons examined histologically.
Steel snares induced significantly deeper tissue injury than tungsten snares in the pure cut mode (Pearson χ2 = 6.136, P = 0.013). The ordinal logistic regression analysis showed that the current mode and snare material were significantly associated with the ordinal score for the depth of injury. Thus, cut mode was positively associated with a lower score and coagulation mode with a higher score. In addition, tungsten was significantly associated with a lower depth of tissue injury.
Due to its inherent electrical properties, tungsten is very well suited for manufacture into electrosurgical endoscopic devices. Thus, tungsten snares may be advantageous for routine use in endoscopic polypectomy, although further studies are needed to confirm these promising findings in human patients.
电切术切除息肉时结肠壁的热损伤可能会导致出血和穿孔等并发症。迄今为止，套扎材料在这些损伤中的作用尚未得到检验。本研究旨在评估钨钢内镜套扎器引起的结肠息肉切除术后热壁损伤的深度，以减少与电外科相关的并发症。
这是一项在猪模型中进行的单中心三级实验研究。在全麻下，三头活猪共进行了 90 例息肉切除术，分别采用钢质和钨质套扎器进行切割、电凝和混合电流模式。然后将猪处死，对其结肠进行组织学检查。
在纯切割模式下，钢套扎器引起的组织损伤明显比钨套扎器深（Pearson χ2 = 6.136，P = 0.013）。有序逻辑回归分析显示，电流模式和套扎材料与损伤深度的有序评分显著相关。因此，切割模式与较低的评分呈正相关，电凝模式与较高的评分呈正相关。此外，钨与组织损伤的深度显著降低相关。
由于其固有的电特性，钨非常适合制成电外科内镜设备。因此，钨制套扎器可能有利于常规用于内镜息肉切除术，尽管需要进一步的研究来证实这些在人类患者中令人鼓舞的发现。
