Hikichi Takuto, Yamasaki Masahiro, Watanabe Ko, Nakamura Jun, Sato Masaki, Takagi Tadayuki, Suzuki Rei, Sugimoto Mitsuru, Kikuchi Hitomi, Konno Naoki, Waragai Yuichi, Asama Hiroyuki, Takasumi Mika, Ejiri Yutaka, Watanabe Hiroshi, Ohira Hiromasa, Obara Katsutoshi
Department of Endoscopy, Fukushima Medical University Hospital.
Fukushima J Med Sci. 2016 Jun 8;62(1):43-50. doi: 10.5387/fms.2015-27. Epub 2016 Mar 26.
To investigate the feasibility of endoscopic submucosal dissection (ESD) using sodium carboxymethylcellulose (SCMC) for gastric cancer.
During October 2011 through April 2013, 98 lesions from 98 patients who underwent ESD using SCMC (ESD-SCMC) for early gastric cancer were enrolled in this study. Two endoscopists, who had each performed fewer than 30 ESD procedures (less-experienced ESD physicians), performed ESD-SCMC under the supervision of two experts. The primary outcome was the en bloc resection rate. Secondary outcomes included the complete resection rate, the procedural time, the bleeding rate after SCMC injection, and complications. Patient characteristics, time necessary for hemostasis after SCMC injection, rate of treatment completion by less-experienced ESD physicians alone, and the effects of SCMC during ESD and on resected specimens were also evaluated.
The en bloc resection rate was 100%. Among these resections, 87.8% of the cases were completed by a less-experienced ESD physician alone. The complete resection rate was 98.0%. The mean total procedural time was 75.4 min. The mean incidence of intraoperative bleeding following SCMC local injection was 1.7 times. No bleeding was observed after SCMC injection in 29.6% of cases (29/98). Five complications occurred: one case of microperforation (1.0%) and four cases of postoperative bleeding (4.0%). SCMC remained in the submucosa. The submucosa was readily manipulated when the deep submucosa was dissected, even after placing the specimen on a slide.
ESD-SCMC is feasible for the resection of early gastric cancer.
探讨使用羧甲基纤维素钠（SCMC）进行内镜黏膜下剥离术（ESD）治疗胃癌的可行性。
2011年10月至2013年4月，本研究纳入了98例接受SCMC辅助ESD（ESD-SCMC）治疗早期胃癌的患者的98个病变。两名各自进行ESD手术少于30例的内镜医师（经验较少的ESD医师）在两名专家的监督下进行ESD-SCMC手术。主要结局是整块切除率。次要结局包括完整切除率、手术时间、SCMC注射后的出血率和并发症。还评估了患者特征、SCMC注射后止血所需时间、仅由经验较少的ESD医师完成治疗的比率以及ESD期间SCMC对切除标本的影响。
整块切除率为100%。在这些切除病例中，87.8%的病例仅由经验较少的ESD医师完成。完整切除率为98.0%。平均总手术时间为75.4分钟。SCMC局部注射后术中出血的平均发生率为1.7次。29.6%的病例（29/98）在SCMC注射后未观察到出血。发生了5例并发症：1例微穿孔（1.0%）和4例术后出血（4.0%）。SCMC保留在黏膜下层。即使将标本放在载玻片上，在剥离深层黏膜下层时，黏膜下层也易于操作。
ESD-SCMC用于早期胃癌切除是可行的。
