Endoscopy Center, Peking University First Hospital, Beijing, China.
Department of Pathology, Peking University First Hospital, Beijing, China.
Turk J Gastroenterol. 2023 Apr;34(4):364-370. doi: 10.5152/tjg.2023.22446.
Colorectal endoscopic submucosal dissection is a technically demanding but effective treatment for superficial neoplasms. We conducted a study to compare the effectiveness and safety of inner traction-facilitated endoscopic submucosal dissection using rubber band and clip with conventional endoscopic submucosal dissection.
We retrospectively evaluated 622 consecutive patients who underwent colorectal endoscopic submucosal dissection between January 2016 and December 2019. To overcome selection bias, we used propensity score matching (1:4) between endoscopic submucosal dissection using rubber band and clip and conventional endoscopic submucosal dissection. The frequency of en bloc resections, R0 resections, curative resections, procedure speed, and complications were evaluated.
After propensity score matching, 35 patients were included in the endoscopic submucosal dissection using rubber band and clip group and 140 were included in the conventional endoscopic submucosal dissection group. Endoscopic submucosal dissection using rubber band and clip resulted in a significant increase in resection speed (0.14 vs. 0.09 cm2/min; P = .003). There were no significant differences in en bloc, R0, and curative resection rates between the 2 groups. In subgroup analysis, the resection speed of endoscopic submucosal dissection using rubber band and clip was significantly higher than that of conventional endoscopic submucosal dissection when the lesions were equal to or larger than 2 cm, macroscopically presenting as lateral spreading tumor, and located in transverse colon to ascending colon.
Endoscopic submucosal dissection using rubber band and clip is safe and effective in treating colorectal neoplasms, especially in lesions presenting a particular difficulty.
结直肠内镜黏膜下剥离术是一种技术要求较高但有效的治疗浅层肿瘤的方法。我们进行了一项研究，比较了使用橡皮圈和夹辅助内镜黏膜下剥离术与传统内镜黏膜下剥离术治疗结直肠肿瘤的效果和安全性。
我们回顾性评估了 2016 年 1 月至 2019 年 12 月期间接受结直肠内镜黏膜下剥离术的 622 例连续患者。为了克服选择偏倚，我们使用橡皮圈和夹辅助内镜黏膜下剥离术与传统内镜黏膜下剥离术之间的倾向评分匹配（1:4）。评估了整块切除率、R0 切除率、根治性切除率、手术速度和并发症的发生率。
经过倾向评分匹配后，35 例患者被纳入橡皮圈和夹辅助内镜黏膜下剥离术组，140 例患者被纳入传统内镜黏膜下剥离术组。橡皮圈和夹辅助内镜黏膜下剥离术显著提高了切除速度（0.14cm2/min 比 0.09cm2/min；P =.003）。两组的整块、R0 和根治性切除率无显著差异。在亚组分析中，当病变等于或大于 2cm、大体表现为侧向扩展肿瘤、位于横结肠至升结肠时，橡皮圈和夹辅助内镜黏膜下剥离术的切除速度明显快于传统内镜黏膜下剥离术。
橡皮圈和夹辅助内镜黏膜下剥离术治疗结直肠肿瘤是安全有效的，特别是在处理具有特殊难度的病变时。
