Department of Gastroenterology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan.
Department of Internal Medicine, Division of Gastroenterology and Hepatology, The Jikei University School of Medicine, Tokyo, Japan.
Surg Endosc. 2021 May;35(5):2110-2118. doi: 10.1007/s00464-020-07614-4. Epub 2020 May 7.
Colorectal endoscopic submucosal dissection (ESD) is technically demanding while ensuring safety, especially in cases with fibrosis and/or poor maneuverability. To overcome such difficulties, we developed a novel method called the pocket-creation method with a traction device (PCM with TD). We then evaluated the effectiveness and safety of PCM with TD in colorectal ESD compared to other conventional methods.
In total, 324 colorectal lesions treated with ESD from July 2018 to June 2019 were included. The following three treatment strategies were used: conventional ESD (CE), CE with TD, and PCM with TD. Patient backgrounds and treatment outcomes were retrospectively compared and analyzed.
As ESD methods, CE, CE with TD, and PCM with TD account for 58% (187/324), 24% (78/324), and 18% (59/324), respectively. No significant difference was observed among the three groups in en bloc and R0 resection rates or adverse events. The rate of lesions with fibrosis and poor maneuverability was significantly higher in the PCM with TD group (CE group vs CE with TD group vs PCM with TD group: fibrosis, 24% vs 47% vs 64%, p < 0.001; poor maneuverability, 5.3% vs 13% vs 20%, p = 0.002). Dissection speed was significantly higher in the PCM with TD than in the CE with TD group (p = 0.003).
PCM with TD can achieve a stable en bloc resection rate and R0 dissection rate without adverse events even in the hands of trainees, irrespective of the size and location of the lesion, presence of fibrosis, and under poor maneuverability conditions.
结直肠内镜黏膜下剥离术（ESD）技术要求高，同时要确保安全，尤其是在纤维化和/或操作困难的情况下。为了克服这些困难，我们开发了一种名为带牵引装置的口袋创建法（PCM with TD）的新方法。然后，我们评估了 PCM with TD 在结直肠 ESD 中的有效性和安全性，与其他传统方法相比。
共纳入 2018 年 7 月至 2019 年 6 月接受 ESD 治疗的 324 例结直肠病变患者。采用以下三种治疗策略：常规 ESD（CE）、CE 加 TD、PCM with TD。回顾性比较和分析患者背景和治疗结果。
作为 ESD 方法，CE、CE 加 TD 和 PCM with TD 分别占 58%（187/324）、24%（78/324）和 18%（59/324）。三组整块和 R0 切除率或不良事件无显著差异。PCM with TD 组纤维化和操作困难的病变比例明显较高（CE 组 vs CE 加 TD 组 vs PCM with TD 组：纤维化，24% vs 47% vs 64%，p<0.001；操作困难，5.3% vs 13% vs 20%，p=0.002）。PCM with TD 组的切割速度明显快于 CE 加 TD 组（p=0.003）。
PCM with TD 可在不发生不良事件的情况下，实现稳定的整块切除率和 R0 切除率，无论病变大小和位置、纤维化程度以及操作困难情况如何，即使是在新手手中。
