Developmental Endoscopy Unit, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, USA.
Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan.
Dig Endosc. 2018 Jan;30(1):65-70. doi: 10.1111/den.12914. Epub 2017 Aug 10.
In Western countries, endoscopic submucosal dissection (ESD) has not prevailed as a result of training problems and a target patient population. We have previously reported a hybrid ESD technique, submucosal endoscopy with mucosal resection (SEMR), in which the submucosal dissection is carried out chiefly by blunt balloon dissection. We have also reported successful application in the porcine colon. In the present study, we compared the safety and efficacy of SEMR with ESD in the porcine esophagus and stomach.
SEMR and ESD were carried out in eight domestic pigs under general anesthesia. Resection sites were marked by circumferential coagulation. After circumferential ESD knife mucosal incision, submucosal fluid cushion (SFC) was created. In the SEMR group, the balloon catheter was inserted deep into the SFC. The balloon was then inflated and pulled back toward the endoscope tip repeatedly, altering the direction, to disrupt the submucosa. Residual strands were cut with an IT-knife. En bloc resection rates, procedure times, complications and dissection difficulty scales (DDS) were recorded prospectively. DDS were rated using a visual analog scale.
Thirty-two resections (8 SEMR/8 ESD in the esophagus; 8 SEMR/8 ESD in the stomach) were done with no major adverse events. There was no statistical difference between the two techniques in either location in the above categories measured.
SEMR and traditional ESD are comparable techniques in safety and effectiveness when carried out in the esophagus and stomach. SEMR may serve as a more appealing technical option for endoscopists who are unable to sustain a traditional ESD practice volume.
在西方国家，由于培训问题和目标患者人群，内镜黏膜下剥离术（ESD）并未普及。我们之前报道了一种混合 ESD 技术，黏膜下内镜切除术（SEMR），其中黏膜下剥离主要通过钝性气囊剥离进行。我们还在猪结肠中成功应用了该技术。在本研究中，我们比较了 SEMR 和 ESD 在猪食管和胃中的安全性和有效性。
在全身麻醉下，对 8 只家猪进行 SEMR 和 ESD。通过环周电凝标记切除部位。环周 ESD 刀切开黏膜后，创建黏膜下流体垫（SFC）。在 SEMR 组中，将气囊导管插入 SFC 深部。然后反复充气并向内镜尖端拉动气囊，改变方向，破坏黏膜下层。用 IT 刀切断残留的条索。前瞻性记录整块切除率、手术时间、并发症和剥离难度评分（DDS）。DDS 通过视觉模拟评分进行评分。
32 例（食管 8 例 SEMR/8 例 ESD；胃 8 例 SEMR/8 例 ESD）均无重大不良事件。在这两个部位的所有类别中，两种技术之间均无统计学差异。
在食管和胃中，SEMR 和传统的 ESD 在安全性和有效性方面是可比的技术。对于无法维持传统 ESD 实践量的内镜医生来说，SEMR 可能是一种更有吸引力的技术选择。
