Masunaga Teppei, Kato Motohiko, Sasaki Motoki, Iwata Kentaro, Miyazaki Kurato, Kubosawa Yoko, Mizutani Mari, Takatori Yusaku, Matsuura Noriko, Nakayama Atsushi, Takabayashi Kaoru, Yahagi Naohisa
Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine Graduate School of Medicine, Tokyo, Japan.
Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine Graduate School of Medicine, Tokyo, Japan.
Endosc Int Open. 2023 Jul 11;11(7):E641-E648. doi: 10.1055/a-2102-7578. eCollection 2023 Jul.
Colorectal endoscopic submucosal dissection (ESD) remains challenging for novice endoscopists. Not only the underwater conditions but also active use of water pressure with the water pressure method (WPM) can help widen the submucosal layer. This study aimed to clarify the usefulness of WPM in colorectal ESD, especially for novice endoscopists. This study was ex vivo and enrolled three novices. Each endoscopist performed conventional ESD (C-ESD) and ESD with WPM (WPM-ESD) 10 times on an excised bovine rectum. The treatment outcomes were compared between the two groups. Median procedure time was significantly shorter in the WPM-ESD group than in the C-ESD group (54 minutes, interquartile range [IQR] 42-67 vs. 45 minutes, IQR 34-55, = 0.035). Although no significant difference in the activation time of electrical surgical unit (ESU) during the procedure was noted, the interval time during the procedure at which the ESU was not activated was significantly shorter in the WPM-ESD group (52 minutes, IQR 40-65 vs. 42 minutes, IQR 32-52, = 0.030) than in the C-ESD group. Moreover, the time required for the endoscope to enter the submucosa was significantly shorter in the WPM-ESD group than in the C-ESD group (8.0 minutes, IQR 6.0-10 vs. 5.0 minutes, IQR 3.0-6.0, < 0.001). The present study reveals that the WPM method significantly shortens the procedure times for novices in colorectal ESD, especially the interval time, which refers to the time spent creating the field of view, and the time required for the endoscope to enter the submucosa.
结直肠内镜黏膜下剥离术（ESD）对于新手内镜医师来说仍然具有挑战性。不仅是水下条件，而且水压法（WPM）积极运用水压也有助于扩大黏膜下层。本研究旨在阐明WPM在结直肠ESD中的有效性，尤其是对新手内镜医师而言。本研究为离体研究，纳入了三名新手。每位内镜医师在切除的牛直肠上分别进行10次传统ESD（C-ESD）和采用WPM的ESD（WPM-ESD）。比较两组的治疗结果。WPM-ESD组的中位手术时间显著短于C-ESD组（54分钟，四分位间距[IQR] 42 - 67分钟 vs. 45分钟，IQR 34 - 55分钟，P = 0.035）。尽管在手术过程中未观察到电外科设备（ESU）激活时间的显著差异，但WPM-ESD组手术过程中ESU未激活的间隔时间显著短于C-ESD组（52分钟，IQR 40 - 65分钟 vs. 42分钟，IQR 32 - 52分钟，P = 0.030）。此外，WPM-ESD组内镜进入黏膜下层所需时间显著短于C-ESD组（8.0分钟，IQR 6.0 - 10分钟 vs. 5.0分钟，IQR 3.0 - 6.0分钟，P < 0.001）。本研究表明，WPM方法显著缩短了新手进行结直肠ESD的手术时间，尤其是间隔时间，即创建视野所花费的时间以及内镜进入黏膜下层所需的时间。
