Ito Renma, Miwa Kazuhiro, Matano Yutaka
Internal Medicine, Komatsu Municipal Hospital, Komatsu 923-0961, Japan.
World J Gastrointest Surg. 2023 Aug 27;15(8):1831-1837. doi: 10.4240/wjgs.v15.i8.1831.
Although endoscopic submucosal dissection (ESD) is becoming more common for early gastric cancer, it requires more advanced techniques and a longer treatment duration than endoscopic mucosal resection. Hybrid ESD using a multifunctional snare (SOUTEN) has been reported to be effective for colorectal lesions, as it can reduce treatment duration. Endoscopic suturing of post-ESD mucosal defects has been reported to reduce the incidence of ESD-related complications.
This study reports outpatient hybrid ESD for early gastric cancer using SOUTEN, followed by endoscopic suturing of post-ESD mucosal defects in an 86-year-old man. On referral for ESD, a 10-mm flat, depressed lesion was found on the posterior wall of the gastric antrum, the depth of which was expected to be mucosal. Given his history of delirium, we performed outpatient endoscopic treatment. The procedure used was hybrid ESD using SOUTEN to reduce the duration of treatment and endoscopic suturing of post-ESD mucosal ESD defects to reduce complications. The procedure time was 62 min and the lesion was completely resected based on histopathological examination, with no reported postoperative complications.
This safe and useful procedure may be especially important for outpatient endoscopic treatment.
尽管内镜下黏膜下剥离术（ESD）在早期胃癌治疗中越来越普遍，但与内镜下黏膜切除术相比，它需要更先进的技术且治疗时间更长。据报道，使用多功能圈套器（SOUTEN）的混合ESD对结直肠病变有效，因为它可以缩短治疗时间。据报道，内镜缝合ESD术后黏膜缺损可降低ESD相关并发症的发生率。
本研究报告了一名86岁男性患者，采用SOUTEN进行早期胃癌门诊混合ESD，随后内镜缝合ESD术后黏膜缺损。因患者转诊行ESD，在胃窦后壁发现一个10毫米的扁平凹陷性病变，预计病变深度仅累及黏膜层。考虑到患者有谵妄病史，我们为其进行了门诊内镜治疗。采用的手术方法是使用SOUTEN进行混合ESD以缩短治疗时间，并在内镜下缝合ESD术后黏膜缺损以减少并发症。手术时间为62分钟，根据组织病理学检查病变被完全切除，且未报告术后并发症。
这种安全有效的手术方法对于门诊内镜治疗可能尤为重要。
