Department of Internal Medicine, Division of Gastroenterology, Soonchunhyang University College of Medicine, Cheonan, Korea.
Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea.
Dig Dis Sci. 2018 Oct;63(10):2773-2779. doi: 10.1007/s10620-018-5140-2. Epub 2018 Jun 7.
Endoscopic submucosal dissection (ESD) with snaring (hybrid ESD) bridges the gap between ESD and endoscopic mucosal resection. We evaluated factors predictive of en bloc and complete resection of large colorectal neoplasms using hybrid ESD.
This was a prospective clinical study of 78 patients who underwent hybrid ESD for excision of colorectal neoplasms (≥ 2 cm) between May 2015 and September 2016 at six university hospitals. We evaluated lesion and patient characteristics, endoscopist experience level (< 50 or ≥ 50 cases with colorectal ESD), and technical factors such as concurrent fibrosis, completion of a circumferential incision, degree of submucosal dissection (< 50 or ≥ 50%), and visualization during snaring (< 50 or ≥ 50%).
Multivariate analyses showed that the en bloc resection rate was significantly related to the degree of visualization during snaring (odds ratio (OR) 7.811, 95% confidence interval [CI] 1.722-35.426; p = 0.008) and the presence of fibrosis (OR 0.258, 95% CI 0.68-0.993; p = 0.049). The complete resection rate was significantly related to the colorectal ESD endoscopist skill level (OR 5.626, 95% CI 1.485-21.313; p = 0.011) and gross lesion type (OR 0.145, 95% CI 0.022-0.936; p = 0.042). When all three technical factors, i.e., completion of circumferential incision, ≥ 50% submucosal dissection, and ≥ 50% visualization during snaring, were satisfied performing hybrid ESD, the en bloc resection rate (87.5%) was similar to that of ESD.
Visualization during snaring, presence of fibrosis, gross lesion type, and endoscopist colorectal ESD experience level affect en bloc or complete resection of large colorectal neoplasia using hybrid ESD.
内镜黏膜下剥离术（ESD）联合圈套（混合 ESD）在 ESD 和内镜黏膜切除术之间架起了桥梁。我们评估了使用混合 ESD 整块切除和完全切除大肠大型肿瘤的预测因素。
这是一项前瞻性临床研究，纳入了 2015 年 5 月至 2016 年 9 月在六所大学医院接受混合 ESD 切除大肠肿瘤（≥2cm）的 78 例患者。我们评估了病变和患者特征、内镜医师经验水平（<50 例或≥50 例大肠 ESD）以及技术因素，如纤维化为、完成环周切口、黏膜下剥离程度（<50%或≥50%）和圈套时的可视性（<50%或≥50%）。
多因素分析显示，整块切除率与圈套时的可视性显著相关（优势比（OR）7.811，95%置信区间[CI] 1.722-35.426；p=0.008）和纤维化的存在（OR 0.258，95%CI 0.68-0.993；p=0.049）。完全切除率与大肠 ESD 内镜医师技术水平显著相关（OR 5.626，95%CI 1.485-21.313；p=0.011）和大体病变类型（OR 0.145，95%CI 0.022-0.936；p=0.042）。当满足完成环周切口、黏膜下剥离≥50%、圈套时可视性≥50%这三个技术因素时，行混合 ESD 的整块切除率（87.5%）与 ESD 相似。
圈套时的可视性、纤维化的存在、大体病变类型和内镜医师大肠 ESD 经验水平影响使用混合 ESD 整块或完全切除大肠大型肿瘤。
