内镜黏膜下剥离术与针型刀和电切刀治疗表浅性食管肿瘤的疗效比较。

Comparison of treatment outcomes between endoscopic submucosal dissection with the needle-type knife and insulated-tip knife for superficial esophageal neoplasms.

机构信息

Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.

Department of Medicine and Bioregulatory Science, Graduate School of Medicine, Kyushu University, Fukuoka, Japan.

出版信息

Dis Esophagus. 2023 Mar 30;36(4). doi: 10.1093/dote/doac067.

DOI:10.1093/dote/doac067

PMID:36190185

Abstract

Our study aimed to compare the treatment outcomes between endoscopic submucosal dissection (ESD) with an insulated-tip knife (ESD-IT) and a needle-type knife (ESD-N) for large superficial esophageal neoplasms, as no study of this kind has been previously reported. We used the dataset of a multicenter, randomized controlled trial that compared conventional ESD (C-ESD) and traction-assisted ESD (TA-ESD) for superficial esophageal neoplasms. We compared the procedural outcomes between ESD-IT and ESD-N in a post hoc analysis and conducted sub-analyses based on traction assistance and electrical knife type. We included 223 (EST-IT, n = 169; ESD-N, n = 54) patients with no significant differences in baseline characteristics. The operator handover rate due to ESD difficulties was significantly higher in ESD-N (ESD-IT = 0.6% vs. ESD-N = 13.0%, P = 0.001), while the injection volume was significantly higher in ESD-IT than in ESD-N (40.0 vs. 20.5 mL, P < 0.001). Other outcomes were comparable between both groups (procedural time: 51.0 vs. 49.5 minute, P = 0.89; complete resection: 90.5% vs. 90.7%, P > 0.99; and complication rate: 1.8% vs. 3.7%, P = 0.60 for ESD-IT and ESD-N, respectively). In the sub-analyses, the handover rate was significantly lower with TA-ESD than with C-ESD for ESD-N (3.2% vs. 26.1%, P = 0.034), and a significantly smaller injection volume was used in TA-ESD than in C-ESD for ESD-IT (31.5 vs. 47.0 mL, P < 0.01). ESD with either endoscopic device achieved favorable treatment outcomes with low complication rates. The handover rate in ESD-N and the injection volume in ESD-IT improved with the traction method.

摘要

我们的研究旨在比较内镜黏膜下剥离术（ESD）中使用绝缘刀头（ESD-IT）和针型刀（ESD-N）治疗大型食管浅表肿瘤的治疗效果，因为此前尚无此类研究。我们使用了一项多中心、随机对照试验的数据集，该试验比较了传统 ESD（C-ESD）和牵引辅助 ESD（TA-ESD）治疗食管浅表肿瘤的效果。我们在事后分析中比较了 ESD-IT 和 ESD-N 之间的程序结果，并根据牵引辅助和电刀类型进行了亚分析。我们纳入了 223 名（ESD-IT，n=169；ESD-N，n=54）患者，他们的基线特征无显著差异。由于 ESD 困难而导致的术者交接率在 ESD-N 中显著更高（ESD-IT=0.6%比 ESD-N=13.0%，P=0.001），而 ESD-IT 的注射量显著高于 ESD-N（40.0 比 20.5 mL，P<0.001）。两组的其他结果相当（操作时间：51.0 比 49.5 分钟，P=0.89；完全切除率：90.5%比 90.7%，P>0.99；并发症发生率：1.8%比 3.7%，P=0.60 分别用于 ESD-IT 和 ESD-N）。在亚分析中，与 C-ESD 相比，TA-ESD 中 ESD-N 的术者交接率显著更低（3.2%比 26.1%，P=0.034），TA-ESD 中 ESD-IT 的注射量也显著小于 C-ESD（31.5 比 47.0 mL，P<0.01）。使用任何一种内镜设备进行 ESD 都能达到良好的治疗效果，且并发症发生率较低。ESD-N 中的交接率和 ESD-IT 中的注射量随着牵引方法的应用而改善。