Guillaumot Marie-Anne, Barret Maximilien, Jacques Jérémie, Legros Romain, Pioche Mathieu, Rivory Jérome, Rahmi Gabriel, Lepilliez Vincent, Chabrun Edouard, Leblanc Sarah, Chaussade Stanislas
Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hopitaux de Paris, and University of Paris, France.
Department of Gastroenterology, Limoges University Hospital, Limoges, France.
Endosc Int Open. 2020 May;8(5):E611-E616. doi: 10.1055/a-1127-3092. Epub 2020 Apr 17.
Endoscopic full-thickness resection allows resection of early gastrointestinal neoplasms not amenable to conventional endoscopic resection techniques, due to their location, presence of submucosal fibrosis, or suspected deep mural invasion. It is typically achieved using a dedicated over-the-scope device (full-thickness resection device or FTRD). The aim of our study was to evaluate the feasibility, safety, and clinical outcomes of endoscopic full-thickness resection using an endoscopic submucosal dissection (ESD) knife. Consecutive patients who underwent full-thickness endoscopic resection at six tertiary care centers from August 2010 to June 2017 were retrospectively included. We conducted a comparative analysis of patient characteristics, technical success, adverse events, and time to discharge between patients treated by a full-thickness resection using an ESD knife. Twenty-one procedures were performed using an ESD knife. En-bloc resection and R0 resection rates were 95.2 % and 65 %, respectively. Clinical symptoms of perforation occurred in 66.7 %. There was no need for surgery or additional endoscopic procedures. Endoscopic full-thickness resection of early colorectal neoplasms using an ESD knife might be feasible and safe. It allows complete resection of lesions with no limitation in size. The technique may be preferable to an other-the-scope resection device in lesions larger than 20 mm, and to surgery in selected cases of low-risk T1 colorectal carcinomas, non-lifting adenomas, submucosal tumors, or technically challenging lesion locations.
内镜全层切除术可用于切除因位置、存在黏膜下纤维化或怀疑有深层壁层浸润而无法采用传统内镜切除技术的早期胃肠道肿瘤。通常使用专用的经内镜装置（全层切除装置或FTRD）来完成。我们研究的目的是评估使用内镜黏膜下剥离术（ESD）刀进行内镜全层切除术的可行性、安全性和临床结果。回顾性纳入了2010年8月至2017年6月在六个三级医疗中心接受全层内镜切除术的连续患者。我们对使用ESD刀进行全层切除治疗的患者的特征、技术成功率、不良事件和出院时间进行了比较分析。使用ESD刀进行了21例手术。整块切除率和R0切除率分别为95.2%和65%。穿孔的临床症状发生率为66.7%。无需进行手术或额外的内镜手术。使用ESD刀对早期结直肠肿瘤进行内镜全层切除术可能是可行且安全的。它可以完整切除病变，且大小不受限制。对于大于20mm的病变，该技术可能比经内镜切除装置更可取，对于低风险T1期结直肠癌、非抬举性腺瘤、黏膜下肿瘤或技术上具有挑战性的病变位置的某些病例，该技术可能比手术更可取。
