Yoshida Naohiro, Doyama Hisashi, Ota Ryosuke, Takeda Yasuhito, Nakanishi Hiroyoshi, Tominaga Kei, Tsuji Shigetsugu, Takemura Kenichi
Naohiro Yoshida, Hisashi Doyama, Ryosuke Ota, Yasuhito Takeda, Hiroyoshi Nakanishi, Kei Tominaga, Shigetsugu Tsuji, Kenichi Takemura, Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Ishikawa 920-8530, Japan.
World J Gastrointest Endosc. 2016 Jun 25;8(12):451-7. doi: 10.4253/wjge.v8.i12.451.
To evaluate efficacy and safety of clip-and-snare method using pre-looping technique (CSM-PLT) for gastric endoscopic submucosal dissection (ESD).
In the CSM-PLT method, a clip attached to the lesion side was strangulated with a snare, followed by application of an appropriate tension to the lesion independent of an endoscope. Twenty consecutive lesions were resected by ESD using CSM-PLT (CSM-PLT group) and compared with a control group, including 20 lesions that were resected by conventional ESD. The control group was matched based on the size and location of the lesion, presence of pathologic fibrosis, and experience of endoscopists. Total procedure time of ESD, proportion of en bloc resection, and complications were analyzed.
The total procedure time for the CSM-PLT group was significantly shorter than that for the control group (38.5 min vs 59.5 min, P = 0.023); all lesions were resected en bloc by ESD. There was no significant difference in complications between the two groups. Moreover, there was no complication in the CSM-PLT group. In one large lesion (size: 74 mm) that underwent extensive CSM-PLT during ESD, we used an additional CSM-PLT on another edge of the lesion after achieving submucosal resection to the maximum extent possible during initial CSM-PLT. In two lesions, the snare came off the lesion together with the clip after a sudden pull; nevertheless, ESD was successful in all lesions.
CSM-PLT was an effective and safe method for gastric ESD.
评估采用预圈套技术的夹闭-圈套法（CSM-PLT）用于胃内镜黏膜下剥离术（ESD）的有效性和安全性。
在CSM-PLT法中，用圈套器勒紧附着于病变侧的夹子，然后在不依赖内镜的情况下对病变施加适当的张力。连续20个病变采用CSM-PLT进行ESD切除（CSM-PLT组），并与对照组进行比较，对照组包括20个采用传统ESD切除的病变。对照组根据病变的大小和位置、病理纤维化的存在情况以及内镜医师的经验进行匹配。分析ESD的总手术时间、整块切除率和并发症。
CSM-PLT组的总手术时间明显短于对照组（38.5分钟对59.5分钟，P = 0.023）；所有病变均通过ESD整块切除。两组并发症无显著差异。此外，CSM-PLT组无并发症发生。在1例ESD术中采用广泛CSM-PLT的大病变（大小：74毫米）中，在初始CSM-PLT期间尽可能进行最大程度的黏膜下切除后，在病变的另一边缘再次采用CSM-PLT。在2例病变中，突然牵拉后圈套器与夹子一起从病变上脱落；然而，所有病变的ESD均成功。
CSM-PLT是一种用于胃ESD的有效且安全的方法。
