Division of Colorectal Surgery, Kaohsiung Veteran General Hospital, Kaohsiung City, Taiwan.
Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.
Dis Colon Rectum. 2021 Feb 1;64(2):241-247. doi: 10.1097/DCR.0000000000001786.
Colorectal endoscopic submucosal dissection is typically performed by specialized knife, such as a dual knife. However, it is not covered by Taiwan's National Health Insurance. In the literature review, using a traditional snare tip for endoscopic submucosal dissection has been reported for stomach lesions only.
The purpose of this study was to evaluate the outcomes of colorectal endoscopic submucosal dissection using a snare tip.
We retrospectively reviewed the clinical using of a snare tip compared with a dual knife for colorectal endoscopic submucosal dissection. Postoperative short- and long-term outcomes were investigated after the procedure.
This study was conducted at a single tertiary care institution.
Patients who could not afford the expense of a specialized knife were included.
Dissection time, dissection speed, and perioperative complications were used for short-term outcome measurement. Recurrence-free rate was used for long-term outcome measurement.
Twenty-one lesions were in the snare tip group and 57 lesions in the dual knife group. The outcomes, including rate of en bloc resection, complication, local recurrence, and recurrence-free interval, between the 2 groups were similar. The mean resected specimen diameter in the dual knife group is larger than the snare tip group (p = 0.041). The dissection time of the snare tip group was shorter than the dual knife group (p = 0.025). However, the dissection speed was significantly slower in the snare tip group than in the dual knife group (p = 0.008).
This study was a retrospective and single doctor chart review in nature with a limited patient number.
The snare tip is an alternative tool for colorectal endoscopic submucosal dissection in a selected population without the support of specialized knives, such as the dual knife. Although the dissection speed is slower using a snare tip, it is still a recommended technique for developing country or low-income patients.
结直肠内镜黏膜下剥离术通常由专用刀（如双极刀）进行。然而，该手术不在台湾全民健康保险范围内。在文献综述中，仅报道了使用传统的圈套器尖端进行内镜黏膜下剥离术治疗胃部病变。
本研究旨在评估使用圈套器尖端进行结直肠内镜黏膜下剥离术的效果。
我们回顾性比较了使用圈套器尖端和双极刀进行结直肠内镜黏膜下剥离术的临床应用。术后对近期和远期结果进行了调查。
本研究在一家三级医疗机构进行。
纳入无法承担专用刀费用的患者。
手术时间、手术速度和围手术期并发症用于评估近期结果，无复发生存率用于评估远期结果。
圈套器尖端组有 21 个病变，双极刀组有 57 个病变。两组的整块切除率、并发症、局部复发率和无复发生存率相似。双极刀组切除标本的平均直径大于圈套器尖端组（p = 0.041）。圈套器尖端组的手术时间短于双极刀组（p = 0.025）。然而，圈套器尖端组的手术速度明显慢于双极刀组（p = 0.008）。
本研究为回顾性、单医生图表回顾，患者数量有限。
在没有专用刀（如双极刀）支持的情况下，圈套器尖端是一种替代工具，可用于结直肠内镜黏膜下剥离术，适用于特定人群。虽然使用圈套器尖端的手术速度较慢，但它仍然是发展中国家或低收入患者的推荐技术。
