Yamamoto Katsumi, Michida Tomoki, Nishida Tsutomu, Hayashi Shiro, Naito Masafumi, Ito Toshifumi
Katsumi Yamamoto, Masafumi Naito, Toshifumi Ito, Department of Gastroenterology, Japan Community Healthcare Organization Osaka Hospital, Osaka 553-0003, Japan.
World J Gastrointest Endosc. 2015 Oct 10;7(14):1114-28. doi: 10.4253/wjge.v7.i14.1114.
Endoscopic submucosal dissection (ESD) is very useful in en bloc resection of large superficial colorectal tumors but is a technically difficult procedure because the colonic wall is thin and endoscopic maneuverability is poor because of colonic flexure and extensibility. A high risk of perforation has been reported in colorectal ESD. To prevent complications such as perforation and unexpected bleeding, it is crucial to ensure good visualization of the submucosal layer by creating a mucosal flap, which is an exfoliated mucosa for inserting the tip of the endoscope under it. The creation of a mucosal flap is often technically difficult; however, various types of equipment, appropriate strategy, and novel procedures including our clip-flap method, appear to facilitate mucosal flap creation, improving the safety and success rate of ESD. Favorable treatment outcomes with colorectal ESD have already been reported in many advanced institutions, and appropriate understanding of techniques and development of training systems are required for world-wide standardization of colorectal ESD. Here, we describe recent technical advances for safe and successful colorectal ESD.
内镜黏膜下剥离术（ESD）在整块切除大型浅表性结直肠肿瘤方面非常有用，但它是一项技术难度较大的手术，因为结肠壁薄，且由于结肠弯曲和可伸展性，内镜操作的灵活性较差。据报道，结直肠ESD存在较高的穿孔风险。为防止穿孔和意外出血等并发症，通过制作黏膜瓣来确保黏膜下层的良好视野至关重要，黏膜瓣是一种可将内镜尖端插入其下方的剥脱黏膜。制作黏膜瓣在技术上通常具有挑战性；然而，各种类型的设备、合适的策略以及包括我们的夹子瓣法在内的新手术方法，似乎有助于黏膜瓣的制作，提高了ESD的安全性和成功率。许多先进机构已经报道了结直肠ESD取得了良好的治疗效果，为实现结直肠ESD的全球标准化，需要对技术有恰当的理解并开发培训系统。在此，我们描述了近期结直肠ESD安全且成功实施的技术进展。
