Department of Endoscopy, The Jikei University School of Medicine, Tokyo 105-8461, Japan.
Endoscopy. 2013 Aug;45(8):661-6. doi: 10.1055/s-0033-1344126. Epub 2013 Jun 27.
Removal of a lesion containing an ulcer scar is one of the most challenging applications of endoscopic submucosal dissection (ESD). The present study examined whether a novel balloon dissector could cleave fibrotic submucosal tissue beneath ulcer scars.
Six pigs were studied. Endoscopic mucosal resection (EMR) with ligation was performed at 7 or 8 sites in the stomach for each animal; 4 weeks later, 23 sites with a visible scar were selected for submucosal dissection. The procedure involved first creating a submucosal fluid cushion (SFC) by injecting either saline mixed with mesna or pure saline. A slender, compliant balloon with a diameter of 8, 13, or 18 mm was inserted into the SFC. The balloon was unfolded and thrust forward to cleave the fibrotic submucosa over approximately 5 cm.
Fibrotic submucosa was dissected within 90 seconds in 17 of 23 attempts. Isolating the ulcer scar from the muscularis with the SFC prior to balloon dissection and using a thinner balloon catheter both ensured a better dissection.
The fibrotic submucosa underlying post-EMR scars can be dissected with the novel balloon dissector, although the technique is less effective in cases with no sign of lifting.
内镜黏膜下剥离术（ESD）中最具挑战性的应用之一是切除含有溃疡瘢痕的病变。本研究旨在探讨一种新型球囊切开器是否能够切开溃疡瘢痕下方的纤维化黏膜下层组织。
本研究纳入了 6 头猪。每头猪的胃内进行了 7 或 8 处内镜黏膜切除术（EMR）结扎术；4 周后，选择 23 处可见瘢痕的部位进行黏膜下剥离。该操作首先通过注射混合有美司钠的生理盐水或纯生理盐水来创建黏膜下流体垫（SFC）。将直径为 8、13 或 18mm 的细长、顺应性好的球囊插入 SFC 中。将球囊展开并向前推进，以切开约 5cm 范围内的纤维化黏膜下层。
在 23 次尝试中，有 17 次尝试在 90 秒内完成了纤维化黏膜下层的剥离。在进行球囊剥离之前，用 SFC 将溃疡瘢痕与肌层隔开，并使用更细的球囊导管，这两者都确保了更好的剥离效果。
新型球囊切开器可用于切开 EMR 后瘢痕下方的纤维化黏膜下层组织，但在没有提起迹象的情况下，该技术效果较差。
