Service d'Hépato-gastro-entérologie, CHU Dupuytren, Limoges, France.
Service d'Hépato-gastro-entérologie, CHU Edouard Herriot, Lyon, France.
Gastrointest Endosc. 2021 Aug;94(2):333-343. doi: 10.1016/j.gie.2021.01.036. Epub 2021 Feb 4.
Colonic endoscopic submucosal dissection (ESD) is particularly challenging and limited to a few expert centers. We recently conducted a pilot study on improvement of colonic ESD with systematic use of a countertraction device (double-clip traction with rubber band [DCT-ESD]).
A French prospective multicenter study was conducted between March 2017 and September 2019, including all consecutive cases of naive colonic ESD. Since the first case of DCT-ESD in March 2017, all cases of colonic ESD have been performed using the DCT-ESD strategy in the 3 centers involved in the study.
Five hundred ninety-nine lesions with a mean size of 53 mm were included in this study, resected by 5 operators in 3 centers. The en bloc, R0, and curative resection rates were 95.7%, 83.5%, and 81.1%, respectively. The adverse event rates were 4.9% for perforation and 4.2% for postprocedure bleeding. Between 2017 and 2019, the rates of R0 and curative resections increased significantly from 74.7% in 2017 to 88.4% in 2019 (P = .003) and from 72.6% in 2017 to 86.3% in 2019 (P = .004), respectively. Procedure duration and speed of resection were 62.4 minutes and 39.4 mm/minute, respectively. No differences were noted between operators.
DCT-ESD is a safe and reproducible technique, with results comparable with those of the large Japanese teams with speed of resection twice as high as previously reported studies. The DCT strategy is promising, cheap, and seems to be reproducible. Physicians performing colonic ESD should be aware of this promising tool to improve their results in ESD.
结肠内镜黏膜下剥离术（ESD）特别具有挑战性，仅限于少数专家中心。我们最近进行了一项关于使用系统的牵引设备（双夹牵引橡皮圈[DCT-ESD]）改善结肠 ESD 的试点研究。
2017 年 3 月至 2019 年 9 月，进行了一项法国前瞻性多中心研究，纳入所有初次接受结肠 ESD 的连续病例。自 2017 年 3 月首例 DCT-ESD 以来，参与研究的 3 个中心的所有结肠 ESD 病例均采用 DCT-ESD 策略进行。
本研究纳入了 599 个平均大小为 53mm 的病变，由 5 名操作者在 3 个中心切除。整块切除率、R0 切除率和治愈性切除率分别为 95.7%、83.5%和 81.1%。穿孔的不良事件发生率为 4.9%，术后出血的不良事件发生率为 4.2%。2017 年至 2019 年期间，R0 切除率和治愈性切除率分别从 2017 年的 74.7%显著增加至 2019 年的 88.4%（P=0.003）和从 2017 年的 72.6%增加至 2019 年的 86.3%（P=0.004）。手术时间和切除速度分别为 62.4 分钟和 39.4mm/min。各操作者之间无差异。
DCT-ESD 是一种安全且可重复的技术，其结果与日本大型团队的结果相当，切除速度比以前报道的研究快一倍。DCT 策略很有前途，成本低廉，似乎具有可重复性。进行结肠 ESD 的医生应该了解这种有前途的工具，以提高他们在 ESD 中的治疗效果。
