Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, Japan.
Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan.
Surg Endosc. 2018 Dec;32(12):5031-5036. doi: 10.1007/s00464-018-6278-x. Epub 2018 Sep 26.
Despite improvements in therapeutic strategy and instrumentation in colorectal endoscopic submucosal dissection (ESD), adverse events sometimes occur. Further advancements in available techniques are required to improve procedural success rates and safety. We developed a novel method for ESD in saline, referred to as "underwater" ESD (UESD). UESD involves using a bipolar needle knife and aims to enable complete resection while minimizing thermal damage to the muscle layer. In this study, we evaluated the safety and efficacy of this new technique.
This was a retrospective study using data from two referral centers and included 40 lesions diagnosed as colorectal epithelial neoplasia (> 20 mm in diameter or with severe fibrosis) and treated with UESD between December 2015 and March 2017. The main outcome measures were technical success rate, incidence of adverse events, and feasibility of histologic evaluation of the resected specimens.
All 40 lesions, including those with submucosal fibrosis, underwent successful en bloc resection using the UESD technique. No procedural adverse events including perforation, delayed bleeding, and electrocoagulation syndrome were observed, and all patients had an uneventful clinical course associated with UESD. In all cases, UESD provided a resected specimen adequate for histological evaluation, without unwarranted burn effect to the tissues.
Our UESD technique was safe and effective for complete resection of colorectal epithelial neoplasia.
尽管结直肠内镜黏膜下剥离术（ESD）的治疗策略和器械有所改进，但不良事件仍时有发生。需要进一步改进现有技术，以提高手术成功率和安全性。我们开发了一种新的盐水内镜黏膜下剥离术（UESD）方法。UESD 采用双极针状刀，旨在实现完全切除，同时最大限度地减少对肌肉层的热损伤。本研究评估了该新技术的安全性和有效性。
这是一项回顾性研究，使用了两个转诊中心的数据，纳入了 2015 年 12 月至 2017 年 3 月期间使用 UESD 治疗的 40 个诊断为结直肠上皮性肿瘤（直径>20mm 或伴有严重纤维化）的病变。主要观察指标是技术成功率、不良事件发生率和对切除标本进行组织学评估的可行性。
所有 40 个病变，包括伴有黏膜下纤维化的病变，均成功地使用 UESD 技术整块切除。未观察到穿孔、延迟出血和电凝综合征等手术不良事件，所有患者均顺利完成 UESD 治疗。所有病例中，UESD 均提供了足够用于组织学评估的切除标本，且组织无不必要的烧伤效应。
我们的 UESD 技术安全有效，可用于完全切除结直肠上皮性肿瘤。
