Zhang Qiang, Xing Tong-Yin, Wang Zhen
a Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology , Nanfang Hospital, Southern Medical University , Guangzhou , China.
Scand J Gastroenterol. 2019 Jan;54(1):114-121. doi: 10.1080/00365521.2018.1549270. Epub 2019 Jan 16.
The use of mucosal traction to assist in colonic and rectal endoscopic submucosal dissection (ESD), especially for deep colonic ESD, is challenging. We developed a method of inverse insertion of a snare into the endoscopic working channel to deliver it into the colon together with the endoscope. With this method, two types of mucosal traction, per-anal external traction (PET) and per-anal internal traction (PIT), could be achieved using a snare with endoclips to assist in ESD (ESD-SE). Here, we aimed to examine its safety and feasibility.
From January 2017 to September 2018, 50 colonic and rectal intraepithelial neoplasias in 50 patients were treated with ESD-SE. Data on lesion location and size, operation time, en bloc resection and R0 resection rates, and operative complications were collected.
Among 50 lesions, 15 lesions were located in the deep colon/proximal colon, and 35 lesions were in the distal colon. The median (interquartile range) size of lesions, submucosal dissection time, and total operation time were 4.5 (3.0-5.0) cm, 32 (18-81) min, and 50 (33-108) min, respectively. All lesions were completely resected, with R0 resection rates of 100%. No intraoperative and postoperative complications occurred. Postoperative pathology revealed 40 and 10 cases of high-grade and low-grade intraepithelial neoplasia, respectively.
The approach using insertion of a selective snare into the colon together with the endoscope, especially into the deep colon, was safe and simple. Use of the snare combined with endoclips could effectively assist in total colonic ESD. Further research is warranted.
利用黏膜牵引辅助结肠和直肠内镜黏膜下剥离术（ESD），尤其是深部结肠ESD，具有挑战性。我们开发了一种将圈套器反向插入内镜工作通道并与内镜一起送入结肠的方法。通过这种方法，使用带有内镜夹的圈套器可实现两种类型的黏膜牵引，即经肛门外部牵引（PET）和经肛门内部牵引（PIT），以辅助ESD（ESD-SE）。在此，我们旨在检验其安全性和可行性。
2017年1月至2018年9月，对50例患者的50处结肠和直肠上皮内瘤变采用ESD-SE进行治疗。收集病变位置和大小、手术时间、整块切除率和R0切除率以及手术并发症的数据。
在50处病变中，15处位于深部结肠/近端结肠，35处位于远端结肠。病变的中位（四分位间距）大小、黏膜下剥离时间和总手术时间分别为4.5（3.0-5.0）cm、32（18-81）分钟和50（33-108）分钟。所有病变均被完全切除，R0切除率为100%。未发生术中及术后并发症。术后病理显示，高级别和低级别上皮内瘤变分别为40例和10例。
将选择性圈套器与内镜一起插入结肠，尤其是深部结肠的方法安全且简单。使用圈套器结合内镜夹可有效辅助全结肠ESD。有必要进行进一步研究。
