水压内镜黏膜下剥离术治疗伴有黏膜下纤维化的结直肠肿瘤的安全性和有效性（附视频）。
Safety and efficacy of water pressure endoscopic submucosal dissection for colorectal tumors with submucosal fibrosis (with video).
机构信息
Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan.
School of Data Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
出版信息
Gastrointest Endosc. 2021 Sep;94(3):607-617.e2. doi: 10.1016/j.gie.2021.03.026. Epub 2021 Mar 30.
BACKGROUND AND AIMS
Colorectal neoplasms with submucosal fibrosis are the most challenging targets of endoscopic resection. Water pressure endoscopic submucosal dissection (WP-ESD) is a recently introduced procedure that has several advantages over conventional endoscopic submucosal dissection (C-ESD). This study aimed to assess the efficacy and safety of WP-ESD for fibrotic colorectal neoplasms.
METHODS
This retrospective observational study investigated 133 colorectal neoplasms expected to have submucosal fibrosis that were resected by WP-ESD or C-ESD between April 2012 and April 2020. Eighty-seven lesions after endoscopic or surgical treatment, 18 with biopsy scar with fold convergence and 28 in patients with ulcerative colitis, were included. The differences in treatment outcomes, including procedure time and adverse event proportions, between the WP-ESD and C-ESD groups were analyzed. The clinical course after perforation using WP-ESD was also evaluated, including postprocedural multidetector CT findings obtained immediately after WP-ESD.
RESULTS
Severe submucosal fibrosis was observed in 96 lesions (72.2%). The median procedure time was significantly shorter in the WP-ESD group than in the C-ESD group (43.5 minutes [interquartile range {IQR}, 32.8-73] vs 72 minutes [IQR, 45-105]; P = .0041). The multivariate analysis revealed WP-ESD as an independent factor for a short procedure time (odds ratio, 2.90; 95% confidence interval, 1.28-6.55). The proportions of post-ESD electrocoagulation syndrome (11.6% vs 13.1%) and perforation (20.4% vs 22.8%) were similar between the groups. Four of 11 patients with perforation who underwent WP-ESD showed fluid collection on postprocedural multidetector CT images.
CONCLUSIONS
WP-ESD can shorten procedure time for treating fibrotic colorectal neoplasms.
背景和目的
黏膜下纤维化的结直肠肿瘤是内镜切除最具挑战性的目标。水压内镜黏膜下剥离术（WP-ESD）是一种最近引入的方法，与传统的内镜黏膜下剥离术（C-ESD）相比具有多项优势。本研究旨在评估 WP-ESD 治疗纤维化结直肠肿瘤的疗效和安全性。
方法
本回顾性观察研究调查了 2012 年 4 月至 2020 年 4 月期间通过 WP-ESD 或 C-ESD 切除的预计有黏膜下纤维化的 133 例结直肠肿瘤。包括内镜或手术治疗后的 87 个病变、18 个活检瘢痕伴褶皱融合和 28 个溃疡性结肠炎患者。分析 WP-ESD 组和 C-ESD 组在治疗结果（包括手术时间和不良事件比例）方面的差异。还评估了使用 WP-ESD 后穿孔的临床过程，包括 WP-ESD 后立即获得的多排 CT 检查结果。
结果
96 个病变（72.2%）存在严重黏膜下纤维化。WP-ESD 组的中位手术时间明显短于 C-ESD 组（43.5 分钟[四分位距（IQR），32.8-73]比 72 分钟[IQR，45-105]；P=.0041）。多变量分析显示 WP-ESD 是手术时间短的独立因素（优势比，2.90；95%置信区间，1.28-6.55）。两组术后电凝综合征（11.6%比 13.1%）和穿孔（20.4%比 22.8%）的比例相似。接受 WP-ESD 的 11 例穿孔患者中有 4 例在术后多排 CT 图像上显示有积液。
结论
WP-ESD 可缩短治疗纤维化结直肠肿瘤的手术时间。
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