水袋辅助内镜黏膜下剥离术治疗胃固有浅层肿瘤（附视频）。
Water-pocket endoscopic submucosal dissection for superficial gastric neoplasms (with video).
机构信息
Department of Gastroenterology, New Tokyo Hospital, Chiba, Japan.
Department of Endoscopy, New Tokyo Hospital, Chiba, Japan.
出版信息
Gastrointest Endosc. 2018 Aug;88(2):253-260. doi: 10.1016/j.gie.2018.04.2331. Epub 2018 Apr 13.
BACKGROUND AND AIMS
During endoscopic submucosal dissection (ESD), a clear view is essential for precise dissection of the appropriate submucosal layer. Some advantages have been reported for underwater techniques of endoscopic resection in comparison with the gas insufflation method. We have developed a new ESD method with the creation of a local water pocket (WP) that provides a clear view in the dissection field. Therefore, we aimed to investigate the feasibility and safety of WP-ESD for superficial gastric neoplasms.
METHODS
We prospectively recruited 50 patients with gastric neoplasms (early gastric cancer or gastric adenomas) between April 2017 and December 2017. Among them, 48 patients were treated with the WP-ESD technique. The patients undergoing WP-ESD were compared with 48 patients treated with standard ESD (S-ESD) who were selected by propensity score matching. The primary outcome was the ESD procedure time.
RESULTS
Total procedure time was significantly shorter in the WP-ESD group than in the S-ESD group (median [interquartile range], 27.5 [19-45] minutes vs 41 [29.8-69] minutes; P < .001). Similarly, the dissection speed was significantly greater in the WP-ESD group than in the S-ESD group (median [interquartile range], 22.5 [16.8-35.3] mm/min vs 17.3 [12.7-22.1] mm/min; P < .001). The rates of complete en bloc resection in the WP-ESD group and the S-ESD group were 97.9% and 95.8%, respectively (P > .99). There were no perforations in either group.
CONCLUSION
WP-ESD was associated with a shorter procedure time than S-ESD. WP-ESD may provide an alternative method for resection of superficial gastric neoplasms. (Clinical trial registration number: UMIN 000030266.).
背景和目的
在内镜黏膜下剥离术（ESD）中，清晰的视野对于准确剥离适当的黏膜下层至关重要。与气腹充气法相比，内镜切除的水下技术具有一些优势。我们开发了一种新的 ESD 方法，通过创建局部水袋（WP）提供清晰的视野。因此，我们旨在探讨 WP-ESD 治疗胃浅表性肿瘤的可行性和安全性。
方法
我们前瞻性招募了 2017 年 4 月至 2017 年 12 月期间的 50 例胃肿瘤患者（早期胃癌或胃腺瘤）。其中，48 例患者接受 WP-ESD 治疗。将接受 WP-ESD 的患者与通过倾向评分匹配选择的 48 例接受标准 ESD（S-ESD）治疗的患者进行比较。主要结局是 ESD 手术时间。
结果
WP-ESD 组的总手术时间明显短于 S-ESD 组（中位数[四分位间距]，27.5[19-45]分钟比 41[29.8-69]分钟；P<0.001）。同样，WP-ESD 组的剥离速度明显快于 S-ESD 组（中位数[四分位间距]，22.5[16.8-35.3]mm/min 比 17.3[12.7-22.1]mm/min；P<0.001）。WP-ESD 组和 S-ESD 组完全整块切除率分别为 97.9%和 95.8%（P>.99）。两组均无穿孔。
结论
WP-ESD 的手术时间短于 S-ESD。WP-ESD 可能为胃浅表性肿瘤的切除提供一种替代方法。（临床试验注册号：UMIN 000030266.）。
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