Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.
Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France.
Endoscopy. 2020 May;52(5):383-388. doi: 10.1055/a-1104-5210. Epub 2020 Feb 7.
Endoscopic submucosal dissection (ESD) of residual or locally recurrent (RLR) colonic lesions after previous endoscopic mucosal resection (EMR) is an attractive but challenging technique. The present study aimed to evaluate the effectiveness and safety of ESD with double clip and rubber band traction (DCT-ESD) of RLR colonic lesions.
We retrospectively analyzed all consecutive DCT-ESD procedures for RLR colonic lesions (rectum excluded) performed in two French centers. The frequency of en bloc and R0 resections, procedure speed, additional surgery, and complications were evaluated. R0 resection was also used to investigate the learning curve.
Among the 53 resections, 49 (92.5 %) were performed en bloc and 42 (79.2 %) achieved R0. The median procedure speed was 21 mm/min. There were four (7.5 %) intraoperative perforations and one delayed bleeding; these were successfully treated endoscopically. There was no salvage surgery for complications. The R0 rate increased from 16/26 (61.5 %) for the first 26 procedures to 26/27 (96.3 %, = 0.002) for the last 27 procedures.
DCT-ESD appears to be a safe and effective treatment for RLR colonic lesions after EMR.
内镜黏膜下剥离术（ESD）治疗内镜下黏膜切除术（EMR）后残余或局部复发（RLR）的结肠病变是一种有吸引力但具有挑战性的技术。本研究旨在评估双夹和橡胶带牵引（DCT-ESD）治疗 RLR 结肠病变的有效性和安全性。
我们回顾性分析了在法国的两个中心进行的所有连续的 DCT-ESD 治疗 RLR 结肠病变（排除直肠）的手术。评估了整块和 R0 切除的频率、手术速度、额外手术和并发症。还使用 R0 切除来研究学习曲线。
在 53 例切除术中，49 例（92.5%）整块切除，42 例（79.2%）达到 R0。中位手术速度为 21mm/min。有 4 例（7.5%）术中穿孔和 1 例延迟出血，均经内镜成功治疗。无并发症行挽救性手术。R0 率从第 1 至 26 例的 16/26（61.5%）增加到第 27 例的 26/27（96.3%，=0.002）。
DCT-ESD 似乎是治疗 EMR 后 RLR 结肠病变的一种安全有效的治疗方法。
