Suzuki Yuichiro, Ohata Ken, Sakai Eiji, Negishi Ryoju, Takita Maiko, Minato Yohei, Muramoto Takeshi, Chiba Hideyuki, Tsuji Yosuke, Matsuhashi Nobuyuki
Department of Gastrointestinal Endoscopy, NTT Medical Center, Tokyo, Japan.
Department of Gastroenterology, Omori Red Cross hospital, Tokyo, Japan.
Endosc Int Open. 2021 Feb;9(2):E210-E215. doi: 10.1055/a-1313-7026. Epub 2021 Feb 3.
Endoscopic submucosal dissection (ESD) has become the standard treatment for colorectal ESD, but large colorectal tumors remain difficult to remove. We developed a new method, called the palisade technique, by modifying the multiple tunneling technique. In this method, a palisade of submucosal tissue is left beneath the tumor to anchor a dissected specimen, maintaining effective submucosal traction. The study included 11 patients with large colorectal tumors that were over half the circumference of the colorectal lumen which were treated using the palisade technique from August 2017 to October 2019. Overall resection outcomes were assessed. All 11 lesions were removed en bloc. The R0 resection rate was 45.6 % because of marginal burning of the specimen, but no local recurrence was found after a median observation period of 31 months. The median submucosal dissection time (SDT) and submucosal dissection speed (SDS) were 170 minutes and 23.1 mm /min, respectively. One case of post-ESD hemorrhage was successfully managed endoscopically, and two cases of post-colorectal ESD coagulation syndrome were managed conservatively. The palisade technique can be an effective and safe technique for treating large colorectal tumors that extend over half the luminal circumference.
内镜黏膜下剥离术（ESD）已成为结直肠ESD的标准治疗方法，但大型结直肠肿瘤的切除仍具有挑战性。我们通过改良多隧道技术开发了一种新方法，称为栅栏技术。在该方法中，在肿瘤下方留下一层黏膜下组织形成栅栏以固定切除的标本，保持有效的黏膜下牵引。该研究纳入了2017年8月至2019年10月期间使用栅栏技术治疗的11例大型结直肠肿瘤患者，肿瘤周长超过结直肠管腔的一半。评估了总体切除结果。所有11个病变均整块切除。由于标本边缘烧灼，R0切除率为45.6%，但在中位观察期31个月后未发现局部复发。黏膜下剥离时间（SDT）中位数和黏膜下剥离速度（SDS）分别为170分钟和23.1毫米/分钟。1例ESD术后出血通过内镜成功处理，2例结直肠ESD术后凝固综合征采用保守治疗。栅栏技术对于治疗周长超过管腔一半的大型结直肠肿瘤可能是一种有效且安全的技术。
