Komori Keishi, Akahoshi Kazuya, Kubokawa Masaru, Motomura Yasuaki, Oya Masafumi, Ihara Eikichi, Nakamura Kazuhiko
Department of Gastroenterology, Aso Iizuka Hospital, Iizuka, Japan.
ANZ J Surg. 2014 Nov;84(11):847-51. doi: 10.1111/ans.12643. Epub 2014 Apr 22.
To reduce the risk of complications related to endoscopic submucosal dissection (ESD) using knives, we developed the Clutch Cutter (CC), which can grasp and incise the target tissue similarly to biopsy techniques using an electrosurgical current. The aim of this study was to evaluate the efficacy and safety of ESD using the CC for removal of rectal carcinoid tumours.
Between December 2009 and December 2011, we prospectively enrolled seven patients (seven lesions) on 7 different days. Patients were endoscopically diagnosed with rectal subepithelial lesions (upper rectum, n = 3; lower rectum, n = 4) within the level 3 layer and without lymph node involvement, with the diagnosis confirmed by preliminary endoscopy, endoscopic ultrasound and endoscopic biopsies. ESD using the CC was performed in all cases, and the therapeutic efficacy, safety and tumour recurrence were assessed.
All lesions were treated easily and safely, and there were no inadvertent incisions. En bloc resection was obtained in all cases, and histologic tumour-free lateral/basal margins were obtained in six of the seven patients. No delayed haemorrhage, perforation or tumour recurrence occurred.
ESD using the CC appears to be an easy, safe and technically efficient method for resecting rectal carcinoid tumour.
为降低使用刀具进行内镜黏膜下剥离术（ESD）相关并发症的风险，我们研发了抓持切割器（CC），它能够像使用电外科电流的活检技术一样抓取并切割目标组织。本研究的目的是评估使用CC进行ESD切除直肠类癌肿瘤的疗效和安全性。
在2009年12月至2011年12月期间，我们在7个不同日期前瞻性纳入了7例患者（7个病变）。患者经内镜诊断为直肠上皮下病变（直肠上段，n = 3；直肠下段，n = 4），位于3层以内且无淋巴结受累，初步内镜检查、内镜超声和内镜活检确诊。所有病例均使用CC进行ESD，并评估治疗效果、安全性和肿瘤复发情况。
所有病变均轻松、安全地得到治疗，未发生意外切割。所有病例均实现整块切除，7例患者中有6例获得组织学无肿瘤的侧切缘/基底切缘。未发生延迟性出血、穿孔或肿瘤复发。
使用CC进行ESD似乎是一种简单、安全且技术上有效的直肠类癌肿瘤切除方法。
