Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China.
Department of Radiology, Guangdong Provincial People' Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China.
Dis Esophagus. 2022 Jan 7;35(1). doi: 10.1093/dote/doab018.
Currently, the reports on esophageal endoscopic submucosal dissection (ESD) assisted by traction with a snare are rare. Because a snare is a commonly used endoscopic accessory and is easily available, its application in mucosal traction is worth exploring. The present study aims to evaluate the safety and effectiveness of snare-endoclip traction-assisted ESD for esophageal intraepithelial neoplasia. Cases of esophageal intraepithelial neoplasia resected using ESD in the Digestive Endoscopy Center of Guangzhou Nanfang Hospital, China from June 2013 to March 2019 were retrospectively analyzed. The procedure of snare-endoclip traction-assisted ESD was compared with nontraction-assisted ESD by using a propensity score matching analysis. Operation time, en bloc and R0 resection, intra- and postoperative complications, and surgery-related costs were mainly evaluated. Overall, 99 cases of esophageal intraepithelial neoplasia under tissue biopsy were included in the present study. Further, 22 exact matched pairs were obtained. There were no differences in en bloc and R0 resection rates, intra- and postoperative complications, and costs of disposable surgical accessories between the traction group and the nontraction group. However, median operation time showed a significant difference: traction group, 50.0 min (range, 20-100 min); nontraction group, 70.0 min (range, 35-133 min), P=0.012. In conclusion, snare-endoclip traction-assisted ESD for esophageal intraepithelial neoplasia was safe and shortened operation time in the study, thereby improving the efficiency of ESD. Despite the additional use of a snare and endoclips for traction, the total costs of endoscopic accessories seemed not to be increased.
目前，关于圈套器辅助牵引内镜黏膜下剥离术（ESD）的报道较少。由于圈套器是一种常用的内镜附件，且易于获得，因此值得探索其在黏膜牵引中的应用。本研究旨在评估圈套器-夹闭器牵引辅助 ESD 治疗食管上皮内瘤变的安全性和有效性。回顾性分析 2013 年 6 月至 2019 年 3 月在中国广州南方医院消化内镜中心接受 ESD 切除的食管上皮内瘤变病例。通过倾向性评分匹配分析，比较了圈套器-夹闭器牵引辅助 ESD 与非牵引辅助 ESD 的手术过程。主要评估手术时间、整块和 R0 切除率、围手术期并发症和与手术相关的费用。总体上，本研究纳入了 99 例经组织活检证实的食管上皮内瘤变患者，进一步获得了 22 对精确匹配的患者。牵引组和非牵引组的整块和 R0 切除率、围手术期并发症和一次性手术器械费用无差异。然而，中位手术时间存在显著差异：牵引组 50.0 min（范围，20-100 min）；非牵引组 70.0 min（范围，35-133 min），P=0.012。总之，在本研究中，圈套器-夹闭器牵引辅助 ESD 治疗食管上皮内瘤变安全有效，可缩短手术时间，提高 ESD 效率。尽管额外使用圈套器和夹闭器进行牵引，但内镜附件的总费用似乎并未增加。
