用于T1期结肠腺癌R0切除的内镜下黏膜下剥离术与内镜全层切除术联合应用
Hybrid endoscopic submucosal dissection and endoscopic full-thickness resection for R0 resection of T1 colonic adenocarcinoma.
作者信息
Karna Rahul, Afraz Iman, Manivel Juan C, Vinsard Daniela Guerrero, Bilal Mohammad
机构信息
Division of Gastroenterology & Hepatology, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
Department of Medicine, Islamabad Medical and Dental College, Islamabad, Pakistan.
出版信息
VideoGIE. 2025 Mar 21;10(7):376-379. doi: 10.1016/j.vgie.2025.03.026. eCollection 2025 Jul.
BACKGROUND AND AIMS
Malignant colorectal polyps limited to superficial submucosa can undergo endoscopic resection as a curative strategy. Endoscopic full-thickness resection (EFTR) allows en bloc resection of malignant polyps; however, the technique is challenging in lesions with submucosal invasion or those >20 mm in size.
METHODS
This original article and accompanying video reviews the technique for hybrid endoscopic submucosal dissection (ESD) and EFTR to allow R0 resection of T1 colonic adenocarcinoma.
RESULTS
In the case example, ESD was performed to make a 35-mm lesion pliable. This step allowed the lesion to be pulled into the cap and complete en bloc resection using the full-thickness resection device.
CONCLUSIONS
The case highlights that hybrid ESD-EFTR technique is feasible and allows for en bloc removal of superficially invasive submucosal colon adenocarcinoma with lesions >20 mm in size. Initial mucosal incision and partial submucosal dissection can make the lesions with underlying submucosal invasion pliable and hence amenable to full-thickness resection using a full-thickness resection device.
背景与目的
局限于浅表黏膜下层的恶性结直肠息肉可通过内镜切除作为一种治愈性策略。内镜全层切除术（EFTR）可完整切除恶性息肉；然而，该技术在伴有黏膜下浸润的病变或直径>20 mm的病变中具有挑战性。
方法
这篇原创文章及随附视频回顾了用于T1期结肠腺癌R0切除的混合内镜黏膜下剥离术（ESD）和EFTR技术。
结果
在该病例中，先进行ESD以使一个35 mm的病变变得易于操作。这一步骤使得病变能够被拉入帽状器械并使用全层切除装置完整切除。
结论
该病例表明，混合ESD-EFTR技术是可行的，并且能够完整切除直径>20 mm的浅表浸润性黏膜下结肠腺癌。初始的黏膜切开和部分黏膜下剥离可使伴有黏膜下浸润的病变变得易于操作，从而能够使用全层切除装置进行全层切除。
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