Song S B, Dou L Z, Liu Y, Zhang Y M, He S, Wang G Q
Department of Endoscopy, National Cancer Center/National Clinical Research Center forCancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
Zhonghua Zhong Liu Za Zhi. 2023 Aug 23;45(8):697-703. doi: 10.3760/cma.j.cn112152-20230216-00064.
To explore the feasibility of endoscopic hand-suturing (EHS) for rectal defects closure after endoscopic submucosal dissection (ESD), and the clinical practicability of EHS combined with titanium clips. This is a prospective study performed by two experienced endoscopists from the Cancer Hospital, Chinese Academy of Medical Sciences who had received EHS training in sixporcine gastric ESD defects before the study. From December 2022 to February 2022, 20 patients with rectal mucosal lesions or submucosal diseases underwent ESD. Then EHS combined with titanium clips was adopted to close the rectal ESD defects. Specifically, we first sutured the defects as much as possible through EHS, then use titanium clips to fix the tail of the suture, and finally use additional titanium clips to close the residual parts of the defects that cannot be sutured. The main observational indicators were complete closure of the wound and delayed bleeding within one month after surgery. In the 20 rectal cases, the size of defects ranged from 2.2 to 3.6 cm, with a median of 2.7 cm. All cases achieved complete closure without delayed bleeding, of which 12 (60.0%) were completely sutured with EHS and 8 (40.0%) required additional titanium clips to achieve complete closure after suturing. EHS technique is feasible and safe for rectum. EHS combined with titanium clips can also effectively close the rectal ESD defects, prevent postoperative delayed bleeding, and may be easier to be implemented in clinical practice.
探讨内镜下手工缝合（EHS）用于内镜黏膜下剥离术（ESD）后直肠缺损闭合的可行性，以及EHS联合钛夹的临床实用性。这是一项前瞻性研究，由中国医学科学院肿瘤医院的两名经验丰富的内镜医师进行，他们在研究前已接受过针对6头猪胃ESD缺损的EHS培训。2022年12月至2022年2月，20例直肠黏膜病变或黏膜下疾病患者接受了ESD。然后采用EHS联合钛夹闭合直肠ESD缺损。具体操作如下，我们首先通过EHS尽可能多地缝合缺损，然后使用钛夹固定缝线的尾部，最后使用额外的钛夹闭合无法缝合的缺损剩余部分。主要观察指标为伤口完全闭合及术后1个月内有无迟发性出血。在20例直肠病例中，缺损大小为2.2至3.6 cm，中位数为2.7 cm。所有病例均实现完全闭合且无迟发性出血，其中12例（60.0%）通过EHS完全缝合，8例（40.0%）在缝合后需要额外的钛夹以实现完全闭合。EHS技术用于直肠可行且安全。EHS联合钛夹还可有效闭合直肠ESD缺损，预防术后迟发性出血，且在临床实践中可能更易于实施。
