Department of Gastroenterology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan.
Sakamoto Endoscopic Clinic, Urayasu, Chiba, Japan.
Med Sci Monit. 2024 Aug 22;30:e945341. doi: 10.12659/MSM.945341.
BACKGROUND The spring-and-loop with clip (S-O clip) consists of a spring and a nylon loop located on one side of the claws of the clip, and is used in gastric endoscopic submucosal dissection (ESD) to allow countertraction. This retrospective study included 290 patients with early gastric neoplasms (eGNs) and aimed to compare postoperative outcomes of ESD with and without the use of the S-O clip. MATERIAL AND METHODS We retrospectively reviewed the data of 347 patients with eGN who underwent ESD, with or without an S-O clip, at our institution between April 1, 2017 and March 31, 2023. Overall, 290 patients were analyzed after excluding ineligible participants. The control group (n=149; adenoma: 1, carcinoma: 148) underwent ESD without an S-O clip between April 2017 and March 2020, while the S-O group (n=141; adenoma: 4, carcinoma: 137) used the clip between April 2020 and March 2023. Primary outcomes included procedure time, en bloc resection rate, and complete resection rate. Subgroup analysis for examined procedure time concerning endoscopist expertise, submucosal fibrosis, and neoplasm locations. RESULTS The S-O group had a shorter procedure time (44.4±23.9 vs 61.1±40.9 min, P<0.001) and a higher complete resection rate (97.9% vs 92.6%, P<0.05) than the control group. Subgroup analysis revealed that the S-O clip significantly reduced procedure time for trainees compared to the control group (40.8±18.3 vs 61.1±35.6 min, P<0.05). CONCLUSIONS The scheduled use of S-O clips in gastric ESD is effective in improving procedural time and complete resection rates, benefiting endoscopists across all experience levels.
Spring-and-loop with clip（S-O 夹）由位于夹爪一侧的弹簧和尼龙环组成，用于胃内镜黏膜下剥离术（ESD）以进行反牵引。本回顾性研究纳入了 290 例早期胃肿瘤（eGN）患者，旨在比较 S-O 夹在 ESD 中的应用与不应用 S-O 夹的术后结果。
我们回顾性分析了 2017 年 4 月 1 日至 2023 年 3 月 31 日期间在我院接受 ESD 治疗的 347 例 eGN 患者的数据，其中包括使用和不使用 S-O 夹的患者。排除不合格患者后，共分析了 290 例患者。对照组（n=149；腺瘤：1 例，癌：148 例）于 2017 年 4 月至 2020 年 3 月期间行 ESD 治疗但不使用 S-O 夹，S-O 组（n=141；腺瘤：4 例，癌：137 例）于 2020 年 4 月至 2023 年 3 月期间使用 S-O 夹。主要结局指标包括手术时间、整块切除率和完全切除率。针对内镜医生的专业知识、黏膜下纤维化和肿瘤位置，对检查手术时间进行亚组分析。
S-O 组的手术时间更短（44.4±23.9 比 61.1±40.9 min，P<0.001），完全切除率更高（97.9%比 92.6%，P<0.05）。亚组分析显示，与对照组相比，S-O 夹显著缩短了学员的手术时间（40.8±18.3 比 61.1±35.6 min，P<0.05）。
在胃 ESD 中计划性使用 S-O 夹可有效缩短手术时间和提高完全切除率，使各级内镜医生均受益。
