Department of Gastroenterology, Asahi General Hospital, Asahi, Japan.
Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan.
Scand J Gastroenterol. 2020 Oct;55(10):1234-1242. doi: 10.1080/00365521.2020.1807597. Epub 2020 Aug 27.
Although scissor-type knives such as the Stag-Beetle (SB) Knife Jr are expected to result in a safe and easy colorectal endoscopic submucosal dissection (CR-ESD), information regarding the learning curve is lacking. Therefore, this study evaluated the learning curve with using SB Knife Jr.
We retrospectively reviewed 507 CR-ESD procedures performed in 464 patients using SB Knife Jr. The primary endpoint was a learning curve to achieve a satisfactory complete resection rate. The secondary endpoints were learning curves to achieve a satisfactory resection rate, curative resection rate, and resection speed.
The complete, , and curative resection rates were 91.9%, 95.9%, and 84.0%, respectively. Moving average analysis showed that 39 cases were required for a complete resection rate of >80%, 41 for an resection rate of >90%, and 50 for a curative resection rate of >75%. We divided the procedure into three phases using the cumulative sum method: I, II, and III (cases 1-36, 37-119, and 120-507, respectively). Although we found no significant between-phase differences, the complete resection rate showed an increasing trend in Phase III (83.3 vs. 89.2 vs. 93.3%; = .099). The resection rate (91.7 vs. 91.6 vs. 97.2%; = .047) and resection speed (20.5 vs. 7.2 vs. 6.8 min/cm; < .001) were greater in Phase III. Despite the larger specimen size (27.3 vs. 38.2 vs. 40.4 mm; < .001) and more severe fibrosis ( < .001) in Phase III, the procedure time was shorter (73.8 vs. 57.8 vs. 54.2 min; = .041). The curative resection rate was not significantly different between phases.
SB Knife Jr enables safe and easy CR-ESD during the introductory period compared to the conventional tip-type knife and has an acceptable learning curve. Therefore, using this knife will encourage the widespread adoption of CR-ESD in Asian general hospitals and non-Asian countries.
尽管诸如 Stag-Beetle（SB）Knife Jr 等剪刀式刀被认为可以安全且轻松地进行结直肠内镜黏膜下剥离术（CR-ESD），但有关学习曲线的信息仍有所欠缺。因此，本研究旨在评估使用 SB Knife Jr 的学习曲线。
我们回顾性分析了使用 SB Knife Jr 为 464 例患者实施的 507 例 CR-ESD 手术。主要终点是达到满意的完全切除率的学习曲线。次要终点是达到满意的切除率、治愈性切除率和切除速度的学习曲线。
完全切除率、 切除率和治愈性切除率分别为 91.9%、95.9%和 84.0%。移动平均分析显示，需要 39 例才能使完全切除率>80%，41 例才能使 切除率>90%，50 例才能使治愈性切除率>75%。我们使用累积和法将手术分为三个阶段：I 期、II 期和 III 期（病例数分别为 1-36、37-119 和 120-507）。尽管我们没有发现各阶段之间有显著差异，但 III 期的完全切除率呈上升趋势（83.3%比 89.2%比 93.3%； =.099）。 切除率（91.7%比 91.6%比 97.2%； =.047）和切除速度（20.5 比 7.2 比 6.8 min/cm； <.001）在 III 期更大。尽管 III 期的标本尺寸较大（27.3 比 38.2 比 40.4 mm； <.001）和纤维化更严重（ <.001），但手术时间更短（73.8 比 57.8 比 54.2 min； =.041）。各阶段的治愈性切除率无显著差异。
与传统尖端型刀相比，SB Knife Jr 在介绍期内可安全且轻松地进行 CR-ESD，且具有可接受的学习曲线。因此，使用这种刀将鼓励亚洲普通医院和非亚洲国家广泛采用 CR-ESD。
