Department of Gastroenterology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China.
Surg Endosc. 2022 Nov;36(11):8231-8236. doi: 10.1007/s00464-022-09266-y. Epub 2022 May 5.
Endoscopic submucosal dissection (ESD) is the treatment of choice for colorectal neoplasms in Japan. ESD can completely peel off the lesion and is associated with a significantly lower recurrence rate of colorectal cancers than EMR and is widely used to treat gastrointestinal tumors. This study aimed to evaluate in vivo traction in endoscopic submucosal dissection (ESD) of proximal colon lesions.
This retrospective study included patients with lesions in the proximal colon who received ESD treatment at Qilu Hospital of Shandong University from June 2018 to December 2020. Patients were divided into two groups according to the in vivo traction method (orthodontic ring or elastic ring) during operation. The operation time, dissection time, proportion of complete resection of lesions, and complications were compared between the two groups.
There were 28 patients in this study. In the orthodontic ring group (n = 10), the average lesion diameter was 2.0-2.5 cm, and the average operation and dissection times were 26.5 ± 7.47 and 21.5 ± 7.47 min, respectively. In the elastic ring group (n = 18), the average lesion diameter was 2.5-5.5 cm, and the average operation and dissection times were 27.39 ± 11.83 and 22.39 ± 11.83 min, respectively. All lesions were completely resected in a single operation, and no wound perforation and delayed bleeding occurred.
In vivo traction-assisted ESD can be used to resect proximal colon lesions in selected patients (precancerous lesions and early colon cancer limited to the mucosa or with a submucosa infiltration depth of < 1000 µm).
内镜黏膜下剥离术（ESD）是日本治疗结直肠肿瘤的首选方法。ESD 可以完全剥离病变，与 EMR 相比，结直肠癌的复发率显著降低，因此被广泛用于治疗胃肠道肿瘤。本研究旨在评估内镜黏膜下剥离术（ESD）治疗近端结肠病变的体内牵引效果。
本回顾性研究纳入 2018 年 6 月至 2020 年 12 月在山东大学齐鲁医院接受 ESD 治疗的近端结肠病变患者。根据术中体内牵引方法（正畸环或弹性环）将患者分为两组。比较两组患者的手术时间、剥离时间、病变完全切除比例和并发症。
本研究共纳入 28 例患者。在正畸环组（n=10）中，平均病变直径为 2.0-2.5cm，平均手术和剥离时间分别为 26.5±7.47min 和 21.5±7.47min。在弹性环组（n=18）中，平均病变直径为 2.5-5.5cm，平均手术和剥离时间分别为 27.39±11.83min 和 22.39±11.83min。所有病变均在单次手术中完全切除，无伤口穿孔和延迟出血发生。
体内牵引辅助 ESD 可用于选择性患者（癌前病变和局限于黏膜或黏膜下浸润深度<1000μm 的早期结肠癌）切除近端结肠病变。
