Jacques Jérémie, Neuhaus Horst, Enderle Markus D, Biber Ulrich, Linzenbold Walter, Schenk Martin, Khalaf Kareem, Repici Alessandro
Department of Hepato-Gastro-Enterology, University Hospital Center, 87042 Limoges, France.
Medical Clinic for Gastroenterology at the Hospital Duesseldorf, 40225 Duesseldorf, Germany.
Diagnostics (Basel). 2023 Oct 30;13(21):3347. doi: 10.3390/diagnostics13213347.
Endoscopic submucosal dissection (ESD) was developed for the removal of benign and early malignant lesions in the gastrointestinal tract. We aimed to evaluate the performance and safety of a novel high-pressure waterjet-assisted ESD knife in colorectal applications. Six female German Landrace pigs with an average weight of 62 kg (range 60-65 kg) were used in this prospective, randomized, and controlled study. Twenty-four ESDs were performed by three endoscopists: Twelve each with the new Erbe HYBRIDknife flex T-Type (HK-T) and the Olympus DualKnife J (DK-J), including six rectal and six colonic ESDs per instrument. The order of performance was randomized regarding anatomic position and instrument. As the primary endpoint, ESD knife performance characteristics were combined and rated on a 5-point Likert scale, with 5 Likert points (LP) representing the best response (5 = very good). The HK-T was rated significantly better than the DK-J (4.7 LP versus 4.4 LP, = 0.0295), mainly because of HK-T injection ability (5 LP versus 3 LP, < 0.0001) and hemostasis (5 LP versus 4 LP, = 0.0452). There was no difference in procedure time (HK-T: 35 min versus DK-J: 34 min, = 0.8005), resection diameter (3.1 cm versus 2.8 cm, = 0.3492), injection volume (41 mL versus 46 mL, = 0.5633), and complication rates. HK-T is as effective as DK-J in colorectal ESD in terms of dissection quality but has better injection and hemostatic properties. The impact of these technical advantages on the ESD treatment of patients with large superficial colorectal lesions remains to be clinically verified.
内镜黏膜下剥离术（ESD）是为切除胃肠道良性和早期恶性病变而开发的。我们旨在评估一种新型高压水刀辅助ESD刀在结直肠应用中的性能和安全性。本前瞻性、随机对照研究使用了6只平均体重62千克（范围60 - 65千克）的德国长白母猪。由三名内镜医师进行了24例ESD手术：分别使用新型爱尔博HYBRIDknife flex T型（HK - T）和奥林巴斯DualKnife J型（DK - J）各进行12例，每种器械包括6例直肠ESD和6例结肠ESD。手术顺序根据解剖位置和器械随机安排。作为主要终点，ESD刀的性能特征进行综合评分，并采用5级李克特量表进行评估，5个李克特分数（LP）代表最佳反应（5 = 非常好）。HK - T的评分显著优于DK - J（4.7 LP对4.4 LP，P = 0.0295），主要是因为HK - T的注射能力（5 LP对3 LP，P < 0.0001）和止血能力（5 LP对4 LP，P = 0.0452）。手术时间（HK - T：35分钟对DK - J：34分钟，P = 0.8005）、切除直径（3.1厘米对2.8厘米，P = 0.3492）、注射量（41毫升对46毫升，P = 0.5633）和并发症发生率均无差异。在结直肠ESD中，就剥离质量而言，HK - T与DK - J效果相当，但具有更好的注射和止血性能。这些技术优势对大的浅表性结直肠病变患者ESD治疗的影响仍有待临床验证。
