Tokuhara Mitsuo, Shimatani Masaaki, Tominaga Kazunari, Nakahira Hiroko, Ohtsu Takuya, Kouda Katsuyasu, Naganuma Makoto
Department of Gastroenterology, Japan Community Healthcare Organization Hoshigaoka Medical Center, Osaka, Japan.
Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University Hirakata Hospital, Osaka, Japan.
Clin Endosc. 2023 Sep;56(5):623-632. doi: 10.5946/ce.2022.200. Epub 2023 May 18.
BACKGROUND/AIMS: Endoscopic resection of all colorectal adenomatous lesions with a low complication rate, simplicity, and negative residuals is challenging. Hence, we developed a new method called "non-injection resection using bipolar soft coagulation mode (NIRBS)" method, adapted for colorectal lesions. In addition, we evaluated the effectiveness of this method.
We performed NIRBS throughout a 12-month period for all colorectal lesions which snare resection was acceptable without cancerous lesions infiltrating deeper than the submucosal layer.
A total of 746 resected lesions were included in the study, with a 4.5 mm mean size (range, 1-35 mm). The major pathological breakdowns were as follows: 64.3% (480/746) were adenomas, and 5.0% (37/746) were intraepithelial adenocarcinomas (Tis lesions). No residuals were observed in any of the 37 Tis lesions (mean size, 15.3 mm). Adverse events included bleeding (0.4%) but no perforation.
NIRBS allowed the resection of multiple lesions with simplicity because of the non-injection and without perforating due to the minimal burn effect of the bipolar snare set in the soft coagulation mode. Therefore, NIRBS can be used to resect adenomatous lesions easily, including Tis lesions, from small to large lesions without leaving residuals.
背景/目的：以低并发症发生率、操作简便且无残留为目标，对所有结直肠腺瘤性病变进行内镜切除具有挑战性。因此，我们开发了一种名为“使用双极软凝模式的非注射切除（NIRBS）”的新方法，适用于结直肠病变。此外，我们评估了该方法的有效性。
在12个月的时间里，我们对所有圈套切除可行且癌性病变未浸润至黏膜下层以下的结直肠病变进行了NIRBS。
该研究共纳入746个切除病变，平均大小为4.5毫米（范围1 - 35毫米）。主要病理分类如下：64.3%（480/746）为腺瘤，5.0%（37/746）为上皮内腺癌（Tis病变）。37个Tis病变（平均大小15.3毫米）均未观察到残留。不良事件包括出血（0.4%），但无穿孔。
由于NIRBS是非注射式的，且双极圈套器在软凝模式下的烧灼效应极小，不会导致穿孔，所以能够简便地切除多个病变。因此，NIRBS可用于轻松切除腺瘤性病变，包括Tis病变，无论病变大小，且不会留下残留。
