新型牵引装置在内镜下黏膜剥离术治疗结直肠病变中的有效性。
Effectiveness of a novel traction device in endoscopic submucosal dissection for colorectal lesions.
机构信息
Department of Gastroenterology, Beijing Chaoyang Hospital, Capital Medical University, 8 Workers Stadium South Road, Chaoyang District, Beijing, 100020, People's Republic of China.
Department of Gastroenterology, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, People's Republic of China.
出版信息
Surg Endosc. 2022 Nov;36(11):8021-8029. doi: 10.1007/s00464-022-09228-4. Epub 2022 Aug 8.
BACKGROUND
Among all types of superficial gastrointestinal (GI) neoplasms, colorectal lesions are recognized as one of the most difficult locations to operate, due to the limited operation space, physiological bends, poor visualization of the submucosal dissection plane sheltered by colorectal crinkle wall, and the thin intestinal mucosa layer which is easy to perforation. The purpose of this prospective study is to evaluate the feasibility, efficacy, and safety of a novel endoscopic traction technique in assisting the endoscopic submucosal dissection (ESD) procedure in colorectal lesions.
METHOD
A total of 117 patients with colonic lesions who underwent endoscopic treatment were enrolled between August 2020 and January 2021 at the endoscopic center of Beijing Chao-yang Hospital of Capital Medical University. Based on whether traction device was used during the operation, 60 and 57 patients were assigned to the conventional ESD group and clips and rubber band triangle traction-assisted ESD group (CRT-ESD, in which three clips and a rubber band were used to form an elastic triangular traction device), respectively. The total procedure time (TPT), submucosal dissection time (SDT), submucosal dissection speed (SDS), and rate of adverse events of the two groups were analyzed.
RESULTS
After excluding patients who did not undergo treatment (conventional ESD, 1; CRT-ESD, 4), 112 patients were included in the study (conventional ESD, 59; CRT-ESD, 53). The baseline characteristics of the patients were well balanced between the two groups. The TPT (58.71 ± 26.22 min vs 33.58 ± 9.88 min, p < 0.001) and SDT (49.24 ± 23.75 min vs 26.34 ± 8.75 min, p < 0.001) were significantly different between the conventional ESD group and CRT-ESD group. The CRT-ESD group had significantly higher SDS than that of the traditional ESD group (0.54 ± 0.42 cm/min vs 0.89 ± 0.40 cm/min, p < 0.001). There were 4 (6.8%) cases of perforation in the traditional ESD group, and no perforation occurred in traction-assisted ESD.
CONCLUSIONS
Compared with traditional ESD, CRT-ESD with clip and rubber band is both safer and more effective in the treatment of colorectal lesions.
背景
在所有类型的胃肠道（GI）表面肿瘤中，结直肠病变由于操作空间有限、生理弯曲、结直肠皱襞下黏膜下剥离平面不易可视化、肠黏膜层薄易穿孔等因素，被认为是最难操作的部位之一。本前瞻性研究旨在评估一种新型内镜牵引技术在辅助结直肠病变内镜黏膜下剥离（ESD）中的可行性、疗效和安全性。
方法
2020 年 8 月至 2021 年 1 月，首都医科大学附属北京朝阳医院内镜中心共纳入 117 例结肠病变患者行内镜治疗。根据术中是否使用牵引装置，将 60 例患者分为常规 ESD 组，57 例患者分为夹和橡胶带三角牵引辅助 ESD 组（CRT-ESD，使用 3 个夹和 1 根橡胶带形成弹性三角牵引装置）。分析两组患者的总手术时间（TPT）、黏膜下剥离时间（SDT）、黏膜下剥离速度（SDS）和不良事件发生率。
结果
剔除未治疗患者（常规 ESD，1 例；CRT-ESD，4 例）后，112 例患者纳入研究（常规 ESD，59 例；CRT-ESD，53 例）。两组患者基线特征均衡。常规 ESD 组和 CRT-ESD 组的 TPT（58.71±26.22 min 比 33.58±9.88 min，p<0.001）和 SDT（49.24±23.75 min 比 26.34±8.75 min，p<0.001）差异有统计学意义。CRT-ESD 组 SDS 明显高于传统 ESD 组（0.54±0.42 cm/min 比 0.89±0.40 cm/min，p<0.001）。传统 ESD 组有 4 例（6.8%）穿孔，牵引辅助 ESD 组无穿孔。
结论
与传统 ESD 相比，夹和橡胶带辅助 CRT-ESD 治疗结直肠病变更安全、更有效。
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