Chiba Hideyuki, Tachikawa Jun, Kurihara Daisuke, Ashikari Keiichi, Goto Toru, Takahashi Akihiro, Sakai Eiji, Ohata Ken, Nakajima Atsushi
Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan.
Department of Gastroenterology, Nerima Hikarigaoka Hospital, Tokyo, Japan.
Endosc Int Open. 2017 Jul;5(7):E595-E602. doi: 10.1055/s-0043-110567. Epub 2017 Jun 23.
Multiple large colorectal lesions are sometimes diagnosed during colonoscopy. However, there have been no investigations of the feasibility of simultaneous endoscopic submucosal dissection (ESD) for multiple lesions. This study aims to reveal the strategy of simultaneous ESD for multiple large colorectal lesions.
246 patients who underwent ESD for 274 colorectal lesions were retrospectively evaluated in this study. Fifty-one large colorectal lesions among 23 patients were treated by ESD simultaneously (simultaneous group), and 223 patients were treated with ESD for a single lesion (single group).
En-bloc resection and curative resection rates did not differ. Compared with the single group, each procedure time was faster (31.8 ± 23.6 min vs. 45.8 ± 44.8, = 0.002), but total procedure time was significantly longer in the simultaneous group (70.6 ± 33.4 vs. 45.8 ± 44.8 min, = 0.01). Rates of adverse events including bleeding and perforation were not higher in the simultaneous group but the mean blood pressure, incidence of bradycardia and the amount of sedative drug used during ESD were significantly higher in the simultaneous group. Multiple logistic regression analysis identified non-experienced physician, lesion size ≥ 40 mm and submucosal fibrosis as an independent risk factor for procedure duration (≥ 90 min) (Odds ratio 11.852, 18.280, and 3.672; < 0.05, respectively).
Simultaneous ESD for multiple synchronous colorectal lesions is safe and feasible compared with single ESD and can reduce the burden to patients, length of hospital stay and medical expense. These results need to be elucidated by further studies.
结肠镜检查时有时会诊断出多个大肠大病变。然而，尚未有关于多个病变同时进行内镜黏膜下剥离术（ESD）可行性的研究。本研究旨在揭示多个大肠大病变同时进行ESD的策略。
本研究对246例因274个大肠病变接受ESD的患者进行了回顾性评估。23例患者中的51个大肠大病变同时接受ESD治疗（同时治疗组），223例患者接受单个病变的ESD治疗（单个病变组）。
整块切除率和根治性切除率无差异。与单个病变组相比，每次手术时间更快（31.8±23.6分钟对45.8±44.8分钟，P = 0.002），但同时治疗组的总手术时间明显更长（70.6±33.4分钟对45.8±44.8分钟，P = 0.01）。同时治疗组包括出血和穿孔在内的不良事件发生率并不更高，但同时治疗组ESD期间的平均血压、心动过缓发生率和镇静药物使用量明显更高。多因素逻辑回归分析确定非经验丰富的医生、病变大小≥40毫米和黏膜下纤维化是手术时间（≥90分钟）的独立危险因素（比值比分别为11.852、18.280和3.672；P均<0.05）。
与单个ESD相比，多个同步大肠病变同时进行ESD是安全可行的，可减轻患者负担、缩短住院时间并降低医疗费用。这些结果需要进一步研究阐明。
