Abe Masahiro, Hayashi Takemasa, Kouyama Yuta, Ide Yutaro, Shibuya Tomoya, Morita Yuriko, Mochizuki Kenichi, Minegishi Yosuke, Tamura Eri, Okumura Taishi, Sakurai Tatsuya, Ogawa Yushi, Maeda Yasuharu, Ichimasa Katsuro, Toyoshima Naoya, Misawa Masashi, Wakamura Kunihiko, Sawada Naruhiko, Baba Toshiyuki, Nemoto Tetsuo, Kudo Shin-Ei
Digestive Disease Center Showa University Northern Yokohama Hospital Yokohama Kanagawa Japan.
APC Microbiome Ireland, College of Medicine and Health, University College Cork Cork Ireland.
JGH Open. 2025 Apr 8;9(4):e70149. doi: 10.1002/jgh3.70149. eCollection 2025 Apr.
Colorectal endoscopic submucosal dissection (ESD) has become a standard treatment for superficial colorectal neoplasms worldwide. However, challenges remain in achieving dissection at the precise layer. In this study, we evaluated the effectiveness of a novel ESD technique involving natural traction, referred to as the bridge formation method (BFM).
The two main features of the BFM are creating a large mucosal flap and leaving normal mucosa on both sides of the lesion until the bridge is made at the end of the procedure. This retrospective study included consecutive patients with 2647 colorectal lesions resected by ESD from September 2003 to December 2023. We divided them into the BFM group and the non-BFM group and conducted propensity score matching.After propensity score matching, 1648 cases were enrolled (824 cases in each group). The en bloc resection rate was significantly higher in the BFM than non-BFM group (99.6% vs. 96.7%, < 0.01). The R0 resection rate and the average dissection speed (㎟/min) were significantly higher in the BFM than non-BFM group (98.8% vs. 96.4%, < 0.01, and 18.9 vs. 18.0, = 0.03). The occurrence rates of perforation and delayed bleeding showed no significant difference between the non-BFM and BFM groups (2.8% vs. 3.6%, = 0.40, and 1.1% vs. 1.0%, = 1.00).
The BFM is a suitable method for colorectal ESD as it enables rapid dissection and improves both en bloc resection and R0 resection rates.
结直肠内镜黏膜下剥离术（ESD）已成为全球浅表性结直肠肿瘤的标准治疗方法。然而，在精确层次进行剥离仍存在挑战。在本研究中，我们评估了一种涉及自然牵引的新型ESD技术——桥接形成法（BFM）的有效性。
BFM的两个主要特点是创建一个大的黏膜瓣，并在病变两侧保留正常黏膜，直到手术结束时形成桥接。这项回顾性研究纳入了2003年9月至2023年12月期间连续接受ESD切除的2647例结直肠病变患者。我们将他们分为BFM组和非BFM组，并进行倾向评分匹配。倾向评分匹配后，共纳入1648例病例（每组824例）。BFM组的整块切除率显著高于非BFM组（99.6%对96.7%，<0.01）。BFM组的R0切除率和平均剥离速度（㎟/min）显著高于非BFM组（98.8%对96.4%，<0.01，以及18.9对18.0，=0.03）。非BFM组和BFM组的穿孔和延迟出血发生率无显著差异（2.8%对3.6%，=0.40，以及1.1%对1.0%，=1.00）。
BFM是一种适用于结直肠ESD的方法，因为它能够实现快速剥离，并提高整块切除率和R0切除率。
