Yamamoto Kenjiro, Itoi Takao, Nagata Naoyoshi, Sofuni Atsushi, Tsuchiya Takayoshi, Ishii Kentaro, Tanaka Reina, Tonozuka Ryosuke, Mukai Shuntaro, Nagai Kazumasa, Asai Yasutsugu, Matsunami Yukitoshi, Matsubayashi Jun, Nagakawa Yuichi
Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan.
Gastrointest Endosc. 2022 Apr;95(4):760-776. doi: 10.1016/j.gie.2021.10.014. Epub 2021 Oct 19.
The optimal electrosurgical unit (ESU) settings for endoscopic papillectomy (EP) have not been investigated. We conducted animal experiments to determine the optimal endoCUT settings with VIO (Erbe, Tübingen, Germany) ESUs and then conducted a small clinical study.
Dedicated animal experimental models were created. To investigate the incision force, chicken meat was resected with a snare whose handle was a hung weight. To investigate the coagulation effect, a surgical needle electrode was inserted into a pig liver and energized, and to determine changes over time in the coagulation status, simulated EP was performed using a living pig. These experiments were performed using the knife-setting or snare-setting endoCUT modes and various effect, duration, and interval settings and compared with results for ICC (Erbe) ESUs. Based on the results, we performed EP in a small number of patients.
The main factor affecting the incision force was duration. The coagulation effect was related to not only effect but also duration. In the endoCUT mode, knife-setting produced a higher incision force and lower coagulation effect. The nondischarge coagulation effect may cause deep ulceration. Based on the animal experiments, we concluded the ideal ESU setting for EP, "VIO EP mode," is knife-setting with high duration, lowest effect, and low interval settings. In the clinical study, there were no significant adverse events such as bleeding, pancreatitis, or perforation.
"VIO EP mode" seems to afford optimal papillectomy. Larger scale clinical studies are needed to accumulate further data and make clinical comparisons with the ICC ESU.
尚未对内镜下乳头切除术（EP）的最佳电外科设备（ESU）设置进行研究。我们进行了动物实验以确定使用VIO（德国图宾根爱尔博公司）ESU时的最佳endoCUT设置，然后开展了一项小型临床研究。
建立专门的动物实验模型。为研究切割力，用一个手柄悬挂重物的圈套器切除鸡肉。为研究凝血效果，将手术针电极插入猪肝并通电，为确定凝血状态随时间的变化，使用活猪进行模拟EP。这些实验使用endoCUT模式的刀设置或圈套器设置以及各种效果、持续时间和间隔设置，并与ICC（爱尔博）ESU的结果进行比较。基于这些结果，我们对少数患者进行了EP。
影响切割力的主要因素是持续时间。凝血效果不仅与效果有关，还与持续时间有关。在endoCUT模式下，刀设置产生更高的切割力和更低的凝血效果。非放电凝血效果可能导致深部溃疡。基于动物实验，我们得出EP的理想ESU设置“VIO EP模式”为高持续时间、最低效果和低间隔设置的刀设置。在临床研究中，未出现出血、胰腺炎或穿孔等重大不良事件。
“VIO EP模式”似乎能提供最佳的乳头切除术。需要开展更大规模的临床研究以积累更多数据，并与ICC ESU进行临床比较。
