Zhang Qiang, Wang Zhen
a Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology , Nanfang Hospital , Guangzhou City , China.
Minim Invasive Ther Allied Technol. 2019 Aug;28(4):227-233. doi: 10.1080/13645706.2018.1518244. Epub 2018 Nov 24.
Assisted endoscopic submucosal dissection (ESD) with mucosal traction remains a challenge. This study explored an approach to assist in esophageal, gastric, colonic, and rectal ESD through a cannula-guided snare with endoclips (CSC-ESD), and aimed to preliminarily evaluate its feasibility in an porcine model. Forty-seven digestive tract mucosae in six pigs were resected using CSC-ESD. The operative time, operative success rate, en bloc resection rate, and intraoperative complications were evaluated. The mean diameter of 12 resected esophageal mucosae was 4.4 ± 1.7 cm and the mean operative time was 24 ± 8 min. The mean diameter of 20 resected gastric mucosae was 3.8 ± 0.9 cm and the operative time was 35 ± 8 min. The mean diameter of 15 resected colonic and rectal mucosae was 3.6 ± 1.0 cm and the operative time was 34 ± 8 min. In all 47 resected mucosae, the en bloc resection rate was 100%, the operative success rate was 100%, and the intraoperative perforation rate was 4.3% (2/47) in the colon. No mucosal bruising or massive bleeding occurred during surgery. The results indicated that this novel assistive method is feasible in esophageal, gastric, colonic and rectal ESD. The further research is worthwhile.
带黏膜牵引的辅助内镜黏膜下剥离术（ESD）仍然具有挑战性。本研究探索了一种通过带内镜夹的套管引导圈套器辅助进行食管、胃、结肠和直肠ESD的方法（CSC-ESD），并旨在在猪模型中初步评估其可行性。使用CSC-ESD切除了6头猪的47处消化道黏膜。评估了手术时间、手术成功率、整块切除率和术中并发症。12处切除的食管黏膜平均直径为4.4±1.7cm，平均手术时间为24±8分钟。20处切除的胃黏膜平均直径为3.8±0.9cm，手术时间为35±8分钟。15处切除的结肠和直肠黏膜平均直径为3.6±1.0cm，手术时间为34±8分钟。在所有47处切除的黏膜中，整块切除率为100%，手术成功率为100%，结肠术中穿孔率为4.3%（2/47）。手术期间未发生黏膜瘀伤或大量出血。结果表明，这种新型辅助方法在食管、胃、结肠和直肠ESD中是可行的。值得进一步研究。
