Department of Gastroenterology, HM Montepríncipe University Hospital, HM Hospitales Group, CEU San Pablo University, Boadilla del Monte, Madrid, Spain.
Department of Gastroenterology, NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK.
Eur J Gastroenterol Hepatol. 2020 Jul;32(7):804-812. doi: 10.1097/MEG.0000000000001703.
Colorectal endoscopic submucosal dissection (CR-ESD) is an evolving technique in Western countries. We aimed to determine the results of the untutored implementation of endoscopic submucosal hydrodissection for the treatment of complex colorectal polyps and establish the learning curve for this technique.
This study included data from 80 consecutive CR-ESDs performed by a single unsupervised western therapeutic endoscopist. To assess the learning curve, procedures were divided into four groups of 20 each.
En bloc resection was achieved in 55, 75, 75 and 95% cases in the consecutive time periods (period 1 vs. 4, P = 0.003). Curative resection was achieved in 55, 75, 70 and 95%, respectively (P = 0.037). Overall, series results demonstrated R0 resection in 75% of cases, with 23.7% requiring conversion to endoscopic piecemeal mucosal resection, and 1.25% incomplete resections. Complications included perforations (7.5%) and bleeding (3.7%). Multivariate analysis revealed factors more likely to result in association with non en bloc vs. En bloc resection, where polyp size ≥35 mm [70 vs. 23.4%; odds ratio (OR) 13.2 (1.7-100.9); P = 0. 013], severe fibrosis [40 vs. 11.7%; OR 10.2 (1.2-86.3); P = 0.033] and where carbon dioxide for insufflation was not used [65 vs. 30%; OR 0.09 (0.01-0.53); P = 0.008].
CR-ESD by hydrodissection has good safety and efficacy profile and offers well tolerated and effective treatment for complex polyps. As such, this technique may be useful in the West, in centers, where previous gastric ESD is not frequent or Japanese mentoring is not possible.
结直肠内镜黏膜下剥离术（CR-ESD）是西方国家一种不断发展的技术。我们旨在确定未经培训的内镜黏膜下注水分离术治疗复杂结直肠息肉的结果，并确定该技术的学习曲线。
本研究纳入了由一位未经监督的西方治疗性内镜医生连续进行的 80 例 CR-ESD 数据。为了评估学习曲线，将手术分为 4 组，每组 20 例。
连续时间段内整块切除率分别为 55%、75%、75%和 95%（第 1 期与第 4 期相比，P=0.003）。治愈性切除率分别为 55%、75%、70%和 95%（P=0.037）。总体而言，该系列结果显示 75%的病例实现了 R0 切除，其中 23.7%需要转为内镜分片黏膜切除术，1.25%的病例切除不完全。并发症包括穿孔（7.5%）和出血（3.7%）。多因素分析显示，与非整块切除相比，更容易导致非整块切除的因素包括息肉大小≥35mm[70%比 23.4%；比值比（OR）13.2（1.7-100.9）；P=0.013]、严重纤维化[40%比 11.7%；OR 10.2（1.2-86.3）；P=0.033]和未使用二氧化碳充气[65%比 30%；OR 0.09（0.01-0.53）；P=0.008]。
经注水分离的 CR-ESD 具有良好的安全性和疗效，为复杂息肉提供了耐受良好且有效的治疗方法。因此，在日本 ESD 不常见或无法获得日本指导的情况下，这种技术可能在西方国家的中心有用。
