内镜黏膜下剥离术治疗大肠大肿瘤。

Endoscopic submucosal dissection for large colorectal neoplasms.

机构信息

Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan.

出版信息

Dig Endosc. 2017 Apr;29 Suppl 2:53-57. doi: 10.1111/den.12850.

DOI:10.1111/den.12850

PMID:28425660

Abstract

BACKGROUND AND AIM

Endoscopic submucosal dissection (ESD) for colorectal neoplasms (CRN) of >50 mm is considered technically difficult. The ITknife nano™ was developed specifically for ESD of CRN and esophageal superficial neoplasms; however, only limited data are available regarding its use in this procedure. Here we assessed the safety and efficacy of ESD using the ITknife nano™ for large CRN (>50 mm).

METHODS

We carried out a retrospective study, including consecutive patients with CRN larger than 50 mm that were treated by ESD between September 2002 and August 2016 at our institution. To clarify features of the ITknife nano™ and to assess its safety and efficacy, we compared en bloc/curative resection rates, complications, and resection speed between ESD done using the Dual knife™ with and without the ITknife nano™.

RESULTS

We analyzed a total of 177 ESD-treated large CRN (median tumor size, 61 mm). Among the 133 CRN treated by ESD using the ITknife nano™, en bloc and curative resection rates were 96.2% and 80.5%, respectively. Perforation occurred in eight cases (6.0%) and delayed bleeding in four cases (3.0%). All complications were endoscopically managed. Resection speed was significantly faster for ESD using the ITknife nano™ (25.3 mm /min) compared to using the Dual knife™ only (19.9 mm /min; P = 0.02).

CONCLUSIONS

Use of the ITknife nano™ for ESD treatment of large CRN (>50 mm) is feasible and may contribute to reduced procedure times. Further controlled studies are needed to confirm these findings.

摘要

背景与目的

内镜黏膜下剥离术（ESD）用于治疗>50mm 的结直肠肿瘤（CRN）被认为具有一定技术难度。ITknife nano™ 是专门为治疗 CRN 和食管表浅肿瘤而开发的，但是，关于其在该手术中的应用，目前仅有有限的数据。在此，我们评估了 ITknife nano™ 在>50mm 大型 CRN 中的 ESD 安全性和有效性。

方法

我们进行了一项回顾性研究，纳入了 2002 年 9 月至 2016 年 8 月在我院接受 ESD 治疗的>50mm 大型 CRN 患者。为了明确 ITknife nano™ 的特点，并评估其安全性和有效性，我们比较了使用和未使用 ITknife nano™ 的 Dual knife™ ESD 的整块切除/根治性切除率、并发症和切除速度。

结果

我们共分析了 177 例接受 ESD 治疗的大型 CRN（肿瘤中位大小为 61mm）。在 133 例接受 ITknife nano™ ESD 治疗的 CRN 中，整块切除率和根治性切除率分别为 96.2%和 80.5%。有 8 例（6.0%）发生穿孔，4 例（3.0%）发生延迟性出血。所有并发症均经内镜处理。使用 ITknife nano™ 的 ESD 速度明显快于仅使用 Dual knife™ 的 ESD（25.3mm/min 比 19.9mm/min；P=0.02）。