常规和牵引辅助食管内镜黏膜下剥离术的技术难度因素。
Factors of technical difficulty in conventional and traction-assisted esophageal endoscopic submucosal dissection.
机构信息
Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
Center for Research and Administration and Support, Biostatistics Division, National Cancer Center, Kashiwa, Japan.
出版信息
Esophagus. 2022 Jul;19(3):452-459. doi: 10.1007/s10388-022-00913-w. Epub 2022 Mar 2.
BACKGROUND
The traction assisted (TA) method has reduced the technical difficulty associated with esophageal endoscopic submucosal dissection (ESD). However, it is unclear which factors associated with difficulty have been improved by the TA-ESD method. We aimed to evaluate and compare difficulty factors between conventional and TA-ESD.
METHODS
We retrospectively enrolled patients treated by ESD from Apr 2010 to Jun 2014 for the conventional ESD cohort and from Jan 2016 to Dec 2019 for the TA-ESD cohort. Difficult cases were defined as; (1) ≥ 120 min ESD procedure time, (2) intraoperative perforation, or (3) piecemeal resection. We explored and compared the factors associated with technical difficulty in each cohort.
RESULTS
The conventional and TA-ESD cohorts included 285 (299 lesions) and 387 (421 lesions) patients, respectively. For difficult cases, the conventional and TA-ESD cohorts had 91 (30%) and 71 (17%) lesions, respectively. Multivariate logistic regression showed that ≥ 30 mm lesion length (odds ratio (OR) 6.85, 95% confidence interval (CI) 3.47-13.50), lower esophagus (OR 2.37, 95% Cl 1.34-4.21), > 1/2 circumference (OR 2.26, 95% CI 1.28-3.99), and left wall (OR 2.72, 95% CI 1.42-5.20) in the conventional ESD cohort, and ≥ 30 mm lesion length (21.30, 95% CI 4.75-95.30), lower esophagus (OR 3.05, 95% CI 1.52-6.13), and > 1/2 circumference (OR 6.40, 95% CI 3.06-13.40) in the TA-ESD cohort, were independently associated with technical difficulty.
CONCLUSIONS
TA-ESD can reduce the difficulty in cases including lesions in the left wall; however, cases in the lower esophagus and large lesions were still difficult to simplify.
背景
牵引辅助（TA）方法降低了食管内镜黏膜下剥离术（ESD）的技术难度。然而，尚不清楚 TA-ESD 方法改善了哪些与难度相关的因素。我们旨在评估和比较传统 ESD 和 TA-ESD 之间的难度因素。
方法
我们回顾性纳入 2010 年 4 月至 2014 年 6 月接受 ESD 治疗的患者为传统 ESD 队列，纳入 2016 年 1 月至 2019 年 12 月接受 TA-ESD 治疗的患者为 TA-ESD 队列。困难病例定义为：（1）ESD 手术时间≥120 分钟，（2）术中穿孔，或（3）分片切除。我们在每个队列中探讨并比较了与技术难度相关的因素。
结果
传统 ESD 队列和 TA-ESD 队列分别纳入 285 例（299 个病灶）和 387 例（421 个病灶）患者。对于困难病例，传统 ESD 队列和 TA-ESD 队列分别有 91 例（30%）和 71 例（17%）病灶。多变量逻辑回归显示，≥30mm 病灶长度（比值比（OR）6.85，95%置信区间（CI）3.47-13.50）、食管下段（OR 2.37，95%CI 1.34-4.21）、≥1/2 周径（OR 2.26，95%CI 1.28-3.99）和左壁（OR 2.72，95%CI 1.42-5.20）为传统 ESD 队列中技术难度的独立相关因素，而≥30mm 病灶长度（OR 21.30，95%CI 4.75-95.30）、食管下段（OR 3.05，95%CI 1.52-6.13）和≥1/2 周径（OR 6.40，95%CI 3.06-13.40）为 TA-ESD 队列中技术难度的独立相关因素。
结论
TA-ESD 可降低左壁病灶的难度，但下段食管和大病灶仍难以简化。
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