Kobara Hideki, Nishiyama Noriko, Fujihara Shintaro, Tada Naoya, Kozuka Kazuhiro, Matsui Takanori, Takata Tadayuki, Chiyo Taiga, Kobayashi Nobuya, Fujita Koji, Yachida Tatsuo, Okano Keiichi, Suzuki Yasuyuki, Nishiyama Akira, Mori Hirohito, Masaki Tsutomu
Department of Gastroenterology and Neurology, Kagawa University, Kagawa, Japan.
Department of Gastroenterological Surgery, Kagawa University, Kagawa, Japan.
Endosc Int Open. 2021 Jan;9(1):E51-E57. doi: 10.1055/a-1287-7482. Epub 2021 Jan 1.
Exposed endoscopic full-thickness resection (EFTR) enables the operator to obtain a sufficient surgical margin. However, insufflation leakage and secure endoscopic full-thickness closure (EFTC) remain problematic. This study aimed to evaluate the safety and feasibility of a new exposed EFTR. Exposed EFTR was performed for 2-cm virtual lesions in different locations of the upper stomach in four dogs. EFTR mainly involved half-circumferential EFTR of the endpoint and clip-line traction. Pulley traction was applied with the forward approach for the greater curvature. EFTC involved endoscopic ligation with O-ring closure to diminish insufflation leakage, followed by over-the-scope clip closure. Complete resection and technical success were achieved in all four cases. One case of intraoperative bleeding was endoscopically managed. No postoperative complications occurred in any cases. The median maximum resected size was 27.5 mm. The median procedure time of the total operation, EFTR, and EFTC was 76, 37, and 35.5 minutes, respectively. The 1-month survival rate was 100 %. This therapeutic strategy may lead to the establishment of exposed EFTR.
暴露式内镜全层切除术（EFTR）可使术者获得足够的手术切缘。然而，气腹泄漏和可靠的内镜全层闭合术（EFTC）仍然是问题所在。本研究旨在评估一种新型暴露式EFTR的安全性和可行性。对4只犬胃上部不同位置的2厘米虚拟病变进行了暴露式EFTR。EFTR主要包括终点的半周向EFTR和夹线牵引。对于胃大弯采用向前推进法进行滑轮牵引。EFTC包括用O形环闭合进行内镜结扎以减少气腹泄漏，随后进行套扎夹闭合。所有4例均实现了完整切除且技术成功。1例术中出血通过内镜处理。所有病例均未发生术后并发症。最大切除尺寸中位数为27.5毫米。总手术、EFTR和EFTC的中位手术时间分别为76、37和35.5分钟。1个月生存率为100%。这种治疗策略可能会促成暴露式EFTR的确立。
