Department of General Surgery, Shanghai Xuhui Center Hospital, Shanghai, China.
Department of Orthopedics, Shanghai Xuhui Center Hospital, Shanghai, China.
Saudi J Gastroenterol. 2023 Mar-Apr;29(2):111-118. doi: 10.4103/sjg.sjg_373_22.
Colorectal endoscopic submucosal dissection (CR-ESD) has become a promising treatment for laterally spreading tumors (LSTs), but is accompanied by great challenges.
.: This study aimed to evaluate the efficacy and safety of CR-ESD with a hybrid knife, versus the conventional technique for LSTs ≥30 mm in diameter, and analyze the risk factors for piecemeal resection and perforation.
Patients eligible for CR-ESD were divided into two groups according to the use of the hybrid knife (HK group) or the use of the conventional technique, with an interchange of injection and hook knife (C-group). We performed propensity score matching (PSM) to compare the HK group and the C-group. Risk predictors for perforation and piecemeal resection were identified.
PSM identified 61 (132 patients) and 61 (129 patients) patients in the C-group and the HK group, respectively. Resection speed was significantly faster in the HK group than in the C-group (18.86 vs. 13.33 mm/min, P < 0.001). The rate of knife exchange was significantly lower in the HK group than in the C-group (1.6% vs. 49.2%, P < 0.001). Multivariate analysis revealed that unfavorable locations, including the splenic flexure, hepatic flexure, or cecum, were predictive of piecemeal resection. The presence of severe fibrosis and a semilunar fold were independent risk factors for perforation.
: The use of a hybrid knife appears to increase CR-ESD resection speed. The indicators for piecemeal resection or perforation in CR-ESD identified herein might help to assess the technical difficulties of CR-ESD.
结直肠内镜黏膜下剥离术（CR-ESD）已成为治疗侧向扩展肿瘤（LST）的一种有前途的方法，但也面临着巨大的挑战。
本研究旨在评估混合刀 CR-ESD 与传统技术治疗直径≥30mm 的 LST 的疗效和安全性，并分析分片切除和穿孔的危险因素。
根据混合刀（HK 组）或传统技术（C 组）的使用情况，将符合 CR-ESD 条件的患者分为两组，两组之间可互换注射和钩刀。我们进行倾向评分匹配（PSM）比较 HK 组和 C 组。确定穿孔和分片切除的风险预测因素。
PSM 确定 C 组和 HK 组分别有 61（132 例）和 61（129 例）例患者。HK 组的切除速度明显快于 C 组（18.86 与 13.33mm/min，P<0.001）。HK 组的刀交换率明显低于 C 组（1.6%与 49.2%，P<0.001）。多因素分析表明，不利位置，包括脾曲、肝曲或盲肠，是分片切除的预测因素。严重纤维化和半月皱襞存在是穿孔的独立危险因素。
混合刀的使用似乎可以提高 CR-ESD 的切除速度。本文确定的 CR-ESD 分片切除或穿孔的指标可能有助于评估 CR-ESD 的技术难度。
