Toyomasu Yoshitaka, Suzuki Masaki, Yanoma Toru, Kimura Akiharu, Kogure Norimichi, Ogata Kyoichi, Ohno Tetsuro, Mochiki Erito, Kuwano Hiroyuki
Department of General Surgical Science (Surgery I), Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan.
Surg Endosc. 2016 Jan;30(1):178-83. doi: 10.1007/s00464-015-4179-9. Epub 2015 Apr 1.
Endoscopic submucosal dissection (ESD) has been used to treat patients with nonulcerated early gastric cancers of 2 cm or less, because the incidence of lymph node metastasis is negligible. However, the standard ESD procedure is long, complex, and associated with high complication rates. To overcome these limitations, we devised a double endoscopic intraluminal operation (DEILO) and assessed its efficacy and safety for superficial gastric neoplasms in a preliminary prospective study.
The DEILO procedure was performed on 101 patients with gastric cancers. Two endoscopes were simultaneously inserted into the stomach. One endoscope was used to lift the lesion, and the other was used to excise the lesion.
The DEILO technique was performed successfully, and en bloc resection was achieved for 98 (97.0%) of 101 patients. Histologically curative resection was achieved for 85 lesions (84.2%). The mean operating time was 70 min (range 20-178 min). Perforation occurred in four patients (4.0%), all of whom were successfully treated nonsurgically. Three patients developed postoperative hemorrhage, which was controlled endoscopically.
The DEILO procedure appears to shorten the operating time for ESD, with efficacy and complication rates comparable with the standard procedure.
内镜黏膜下剥离术（ESD）已被用于治疗直径2厘米及以下的非溃疡性早期胃癌患者，因为其淋巴结转移发生率可忽略不计。然而，标准的ESD手术耗时较长、操作复杂且并发症发生率高。为克服这些局限性，我们设计了一种双内镜腔内手术（DEILO），并在一项初步前瞻性研究中评估了其对浅表性胃肿瘤的疗效和安全性。
对101例胃癌患者实施了DEILO手术。将两根内镜同时插入胃内。一根内镜用于提起病变，另一根用于切除病变。
DEILO技术成功实施，101例患者中有98例（97.0%）实现整块切除。85个病变（84.2%）实现了组织学根治性切除。平均手术时间为70分钟（范围20 - 178分钟）。4例患者（4.0%）发生穿孔，均通过非手术方法成功治疗。3例患者术后发生出血，通过内镜控制。
DEILO手术似乎缩短了ESD的手术时间，其疗效和并发症发生率与标准手术相当。
