Ribeiro-Mourão Francisco, Veloso Nuno, Dinis-Ribeiro Mário, Pimentel-Nunes Pedro
CINTESIS/CIDES, Faculdade de Medicina do Porto, Porto, Portugal.
Gastroenterology Department, Instituto Português de Oncologia do Porto Francisco Gentil, Porto, Portugal.
GE Port J Gastroenterol. 2015 Mar 20;22(2):52-60. doi: 10.1016/j.jpge.2015.01.002. eCollection 2015 Mar-Apr.
Endoscopic submucosal dissection (ESD), an endoscopic technique used for treatment of gastric superficial lesions, has been gaining importance on western countries. Procedural times have an impact on various outcomes.
To define which factors from patients, lesions and procedure can predict longer procedural times.
In a cohort of 127 lesions resected by ESD with IT-knife, after using needle-knife for submucosal layer access, by experienced gastroenterologists, characteristics from the patient (age, gender, presence of co-morbidities, usage and suspension of anti-platelet drugs and general physical condition), lesion (size, histopathological diagnosis at biopsy, location, macroscopic type and submucosal invasion) and procedure (adverse events) were retrospectively analyzed for its impact on time of procedure. Univariate and multivariate analysis were performed.
Lesions larger than 20 mm ( < 0.001), on the upper third of the stomach ( = 0.035) and with an ASA score of 3 ( = 0.031) were considered influential factors for a longer procedure time and specifically for a time of procedure longer than 90 min. Existence of intra-procedure adverse events was also a predictor for a procedure time >90 min. Lesion's size >20 mm and location in the upper third were independently associated with a procedure time longer than 90 min (OR 4.91 [95%CI 2.29-10.50] and OR 18.26 [95%CI 2.02-164.78], respectively).
The time of procedure of ESD for gastric superficial lesions is influenced by size of lesion (>20 mm) and location (upper third of stomach), which predict a time longer than 90 min. This can be useful for better management of workflow, operation, training of teams and anesthesic procedures.
内镜黏膜下剥离术（ESD）是一种用于治疗胃浅表病变的内镜技术，在西方国家正变得越来越重要。手术时间会对各种结果产生影响。
确定患者、病变和手术中的哪些因素可预测较长的手术时间。
在一组由经验丰富的胃肠病学家使用IT刀进行ESD切除的127个病变中，在使用针刀进入黏膜下层后，回顾性分析患者的特征（年龄、性别、合并症的存在、抗血小板药物的使用和停用以及一般身体状况）、病变（大小、活检时的组织病理学诊断、位置、宏观类型和黏膜下浸润）和手术（不良事件）对手术时间的影响。进行单因素和多因素分析。
大于20毫米的病变（<0.001）、位于胃上三分之一处（=0.035）以及美国麻醉医师协会（ASA）评分为3（=0.031）被认为是手术时间较长的影响因素，特别是对于手术时间超过90分钟的情况。术中不良事件的存在也是手术时间>90分钟的一个预测因素。病变大小>20毫米和位于上三分之一处与手术时间超过90分钟独立相关（分别为OR 4.91 [95%CI 2.29 - 10.50]和OR 18.26 [95%CI 2.02 - 164.78]）。
胃浅表病变ESD的手术时间受病变大小（>20毫米）和位置（胃上三分之一）的影响，这预示着手术时间超过90分钟。这对于更好地管理工作流程、手术、团队培训和麻醉程序可能有用。
