Hirota Masashi, Kato Motohiko, Yamasaki Makoto, Kawai Naoki, Miyazaki Yasuhiro, Yamada Takuya, Takahashi Tsuyoshi, Takehara Tetsuo, Mori Masaki, Doki Yuichiro, Nakajima Kiyokazu
Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan.
Endoscopy. 2014 Jun;46(6):499-502. doi: 10.1055/s-0034-1364879. Epub 2014 Jan 28.
A novel esophageal endoscopic submucosal dissection (ESD) technique was devised using a newly developed overtube to achieve adequate tissue traction. The aim of this study was to evaluate the feasibility and safety of this new full-traction ESD (tESD) technique.
The key feature of tESD is tissue traction by grasping forceps, which is passed through the built-in side channel of the overtube. The strength and direction of traction is controlled by rotating the overtube and by adjusting its depth. The en bloc resection rate, procedure time, adverse events, and dissected area per minute were evaluated in a porcine model (n = 10) and compared with those of conventional ESD (n = 10).
tESD provided robust and adjustable tissue traction during the procedure. En bloc resection was accomplished in all lesions with no complications. Median procedure time was similar to that of the conventional technique (25 vs. 27 minutes; P = 0.4723) but the submucosal injection catheter was used less often (1.5 vs. 6; P < 0.01).
tESD might contribute to more efficient esophageal ESD by providing adequate tissue traction. This inexpensive technique may become an attractive option in esophageal ESD.
设计了一种新型食管内镜黏膜下剥离术（ESD），使用新开发的外套管实现足够的组织牵引。本研究的目的是评估这种新型全牵引ESD（tESD）技术的可行性和安全性。
tESD的关键特征是通过外套管内置侧通道的抓钳进行组织牵引。通过旋转外套管并调整其深度来控制牵引的强度和方向。在猪模型（n = 10）中评估整块切除率、手术时间、不良事件和每分钟剥离面积，并与传统ESD（n = 10）进行比较。
tESD在手术过程中提供了强大且可调节的组织牵引。所有病变均实现整块切除，无并发症。中位手术时间与传统技术相似（25分钟对27分钟；P = 0.4723），但黏膜下注射导管的使用频率较低（1.5次对6次；P < 0.01）。
tESD通过提供足够的组织牵引可能有助于提高食管ESD的效率。这种成本低廉的技术可能成为食管ESD中一个有吸引力的选择。
