Wang Wenhai, Li Peng, Ji Ming, Wang Yongjun, Zhu Shengtao, Liu Lihua, Zhang Shutian
Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, China.
Minim Invasive Ther Allied Technol. 2019 Oct;28(5):268-276. doi: 10.1080/13645706.2019.1602544. Epub 2019 Apr 16.
The aim of this study was to compare and analyze the feasibility and safety of two methods of endoscopic full-thickness resection (EFTR) for the management of challenging epithelial and subepithelial neoplasms that are not amenable to resection techniques. This was a retrospective case series study of patients who underwent one of two methods of EFTR, resection using ESD knives and post-resection closure with OTSC (Group 1), or closure with OTSC and secondary EFTR with snare (Group 2). Of 11 patients, six were in Group 1 and five in Group 2. The mean time of the EFTR procedure was 76.83 ± 34.97 min in Group 1 which is significantly longer than that of Group 2 ( = .0128). The mean time of OSTC closure and length of hospital stay of Group 1 were also longer compared to Group 2, but the difference was not significant. Complete resection (R0) and technical success rates of Group 1 and Group 2 were 83.3% and 100% ( = .338), respectively. VAS scores of Group 1 immediately after the operation and after 24 h are significantly higher than those of Group 2 ( = .047 and = .009, respectively). In Group 1, one patient had delayed perforation which led to fever and pneumoperitoneum, and one patient developed abdominal pain. No complications associated with the endoscopic procedure were observed in Group 2. EFTR of pre-resection closure are potentially faster compared with the concept of applying closure after EFTR. Larger prospective controlled studies comparing these two techniques are warranted in the future.
本研究的目的是比较和分析两种内镜全层切除术（EFTR）方法在处理难以切除的上皮性和上皮下肿瘤时的可行性和安全性。这是一项回顾性病例系列研究，研究对象为接受两种EFTR方法之一的患者，即使用内镜黏膜下剥离术（ESD）刀切除并使用一次性内镜缝合夹（OTSC）进行切除后闭合（第1组），或使用OTSC闭合并使用圈套器进行二次EFTR（第2组）。11例患者中，6例在第1组，5例在第2组。第1组EFTR手术的平均时间为76.83±34.97分钟，明显长于第2组（P = 0.0128）。与第2组相比，第1组OTSC闭合的平均时间和住院时间也更长，但差异不显著。第1组和第2组的完全切除（R0）率和技术成功率分别为83.3%和100%（P = 0.338）。第1组术后即刻和术后24小时的视觉模拟评分（VAS）明显高于第2组（分别为P = 0.047和P = 0.009）。在第1组中，1例患者发生延迟穿孔，导致发热和气腹，1例患者出现腹痛。第2组未观察到与内镜手术相关的并发症。与EFTR后应用闭合的概念相比，切除前闭合的EFTR可能更快。未来有必要进行更大规模的前瞻性对照研究来比较这两种技术。
