Department of Gastroenterology, Fuyang People's Hospital (Fuyang people's Hospital Affiliated to Anhui Medical University), Fuyang, China.
Surg Laparosc Endosc Percutan Tech. 2022 Dec 1;32(6):637-642. doi: 10.1097/SLE.0000000000001121.
Single-balloon enteroscopy (SBE) is a safe and effective modality for the diagnosis and therapeutic treatment of small bowel disorders. However, the efficacy and safety of treating small bowel submucosal tumors (SMTs) with endoscopic submucosal dissection (ESD) or endoscopic full-thickness resection (EFTR) during SBE have not been determined. Hence, the primary aim of this study was to prospectively evaluate the therapeutic yield of SBE in patients with SMTs.
Twenty-one patients with SMTs were enrolled in this study. Regarding the sex distribution, there were 12 men (57.1%) and 9 women (42.9%). Regarding the age distribution, 42.9% of the patients were 60 years old or older and 57.1% of the patients were under 60 years old. The preoperative characteristics of SMTs were summarized and analyzed, the complete resection incidence of SMTs was determined, and the incidence of postoperative complications was collected. ESD-related and EFTR-related complications and the duration of follow-up after leaving hospital were also summarized and analyzed. The efficacy and safety of SMTs treated by ESD or EFTR during SBE were calculated as percentages.
Among the 21 patients, 10 (47.6%) underwent EFTR and 11 (52.4%) underwent ESD. The mean diameter of SMTs was 113.50 mm (range: 80 to 160 mm). Anterograde and retrograde SBE were conducted in 11 and 10 patients, respectively. The mean follow-up time was 49.3 days (range: 6.0 to 129 d). The complete resection rate of SMTs was 100%. The complete suture rate of SMTs wound was 100%. The SMTs pathology of all patients showed that the margin-negative (R0) resection was 100%. The incidence of physical discomfort complications (ie, infection/fever, abdominal pain, and abdominal distension) of ESD and EFTR was 5 (23.8%) on day 1, 1 (4.8%) on day 2, and 1 (4.8%) on day 3 after operation. Only 1 (4.8%) patient with EFTR had abdominal pain on the sixth day after leaving hospital, and the visual analog scale/score was 1 point, meaning the pain was easily tolerated by the patient. Twenty (95.2%) patients had no abdominal discomfort after leaving hospital. No patients needed additional surgery because of complications after ESD or EFTR during SBE.
This preliminary study showed that SMTs can be safely and effectively treated by ESD or EFTR during SBE, particularly SMTs <160 mm in diameter.
单气囊小肠镜（SBE）是一种安全有效的诊断和治疗小肠疾病的方法。然而，在 SBE 中使用内镜黏膜下剥离术（ESD）或内镜全层切除术（EFTR）治疗小肠黏膜下肿瘤（SMT）的疗效和安全性尚未确定。因此，本研究的主要目的是前瞻性评估 SBE 治疗 SMT 的治疗效果。
本研究纳入了 21 例 SMT 患者。在性别分布方面，男性 12 例（57.1%），女性 9 例（42.9%）。在年龄分布方面，42.9%的患者年龄在 60 岁及以上，57.1%的患者年龄在 60 岁以下。总结分析了 SMT 的术前特征，确定了 SMT 的完全切除率，并收集了术后并发症的发生率。还总结分析了 ESD 相关和 EFTR 相关并发症以及出院后随访的时间。计算了 SBE 中 ESD 或 EFTR 治疗 SMT 的疗效和安全性的百分比。
在 21 例患者中，10 例（47.6%）接受 EFTR 治疗，11 例（52.4%）接受 ESD 治疗。SMT 的平均直径为 113.50mm（范围：80-160mm）。11 例患者进行了顺行 SBE，10 例患者进行了逆行 SBE。平均随访时间为 49.3 天（范围：6.0-129d）。SMT 的完全切除率为 100%。SMT 创面完全缝合率为 100%。所有患者的 SMT 病理均显示边缘阴性（R0）切除率为 100%。ESD 和 EFTR 术后第 1 天、第 2 天和第 3 天的物理不适并发症（即感染/发热、腹痛和腹胀）发生率分别为 5（23.8%）、1（4.8%）和 1（4.8%）。仅 1 例（4.8%）EFTR 患者在出院后第 6 天出现腹痛，视觉模拟评分/分数为 1 分，表明患者可轻松耐受疼痛。20（95.2%）例患者出院后无腹部不适。由于 SBE 中 ESD 或 EFTR 后的并发症，没有患者需要额外的手术。
本初步研究表明，SBE 中可安全有效地使用 ESD 或 EFTR 治疗 SMT，尤其是直径<160mm 的 SMT。
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