Developmental Endoscopy Lab, Harvard Medical School, Boston, Massachusetts, USA; Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Gastrointest Endosc. 2019 Jan;89(1):177-184. doi: 10.1016/j.gie.2018.08.032. Epub 2018 Aug 25.
The lack of reliable countertraction in endoscopic submucosal dissection (ESD) contributes to its technical demand and increased procedure time. We aimed to prospectively evaluate the efficacy of the suture pulley countertraction method in endoscopists new to both suturing and ESD.
Two 30-mm circular lesions were created in an ex vivo porcine stomach model. Endoscopists considered novices for both endoscopic suturing and ESD were randomized to either traditional or suture pulley ESD first and performed ESD using each technique. Procedure time was recorded including time of circumferential incision, suture pulley placement, and submucosal dissection. After completion of each ESD, participants graded the difficulty of the procedure using the National Aeronautical and Space Administration (NASA) Task Load Index.
Thirteen participants (8 fellows, 5 attendings) completed the study using both methods. Mean total procedure time was shorter using suture pulley ESD compared with traditional ESD (26.7 ± 7.3 vs 59.4 ± 20.4 minutes, P < .001). The suture pulley required a mean 6.2 ± 2.1 minutes to place. Submucosal dissection time was shorter using suture pulley ESD compared with traditional ESD (8.4 ± 2.9 vs 47.2 ± 16.3 minutes, P < .001). All 7 individual indices and total score on the NASA Task Load Index were significantly improved using the suture pulley ESD method (P < .001).
The suture pulley countertraction method significantly decreases procedure time and technical demand of ESD among endoscopists at all skill levels who are new to ESD. The results of this study have potential implications for ESD training in the United States.
内镜黏膜下剥离术（ESD）缺乏可靠的反牵引力，这增加了其技术难度并延长了手术时间。我们旨在前瞻性评估缝线滑轮牵引法在内镜缝合和 ESD 均为新手的内镜医师中的疗效。
在离体猪胃模型中创建两个 30mm 的圆形病变。将内镜缝合和 ESD 均视为新手的 13 名参与者（8 名研究员，5 名主治医生）随机分为传统 ESD 组或缝线滑轮 ESD 组，分别使用两种技术进行 ESD。记录包括环周切口、缝线滑轮放置和黏膜下剥离在内的手术时间。完成每例 ESD 后，参与者使用美国国家航空航天局（NASA）任务负荷指数（Task Load Index）对手术难度进行评分。
13 名参与者均完成了两种方法的研究。与传统 ESD 相比，缝线滑轮 ESD 的总手术时间更短（26.7 ± 7.3 比 59.4 ± 20.4 分钟，P <.001）。放置缝线滑轮平均需要 6.2 ± 2.1 分钟。与传统 ESD 相比，缝线滑轮 ESD 的黏膜下剥离时间更短（8.4 ± 2.9 比 47.2 ± 16.3 分钟，P <.001）。NASA 任务负荷指数的 7 个单项指标和总分在使用缝线滑轮 ESD 方法时均显著改善（P <.001）。
缝线滑轮反牵引力法可显著缩短 ESD 术时间和技术难度，尤其适用于内镜缝合和 ESD 均为新手的各级内镜医师。该研究结果可能对美国的 ESD 培训具有重要意义。
