Background and Aims

Generally, colorectal endoscopic submucosal dissection (ESD) is performed with a monopolar knife with CO₂ supply from an endoscope. There are few case reports about underwater ESD (UESD) in saline solution with a bipolar knife. The usefulness and safety of UESD in saline solution with a monopolar knife are unclear. The present study aimed to investigate the usefulness and safety of UESD in saline solution with a monopolar knife for colorectal tumors.

Methods

This retrospective, observational study on UESD for colorectal tumors included 26 colorectal tumors from 24 patients treated with UESD at our department between October 2015 and February 2017. The characteristics of patients, factors associated with ESD difficulty, treatment results, and variations in blood test data before and after UESD were analyzed.

Results

En bloc resection was successful in all lesions without any serious adverse events. The median major diameter of the resected specimens was 30 mm (interquartile range [IQR], 28-35) and of the tumor 22.5 mm (IQR, 17.8-25.3). The median procedure time was 60 minutes (IQR, 45-111) and median speed of dissection 10.4 mm²/min (IQR, 6.4-12.2). No cases of perforation occurred. Post-ESD bleeding occurred in only 1 case, and endoscopic hemostasis was achieved. There was no case of electrolyte imbalance requiring treatment after UESD.

Conclusions

UESD in saline solution with a monopolar knife for colorectal tumors is useful and safe. UESD has potential advantages that should be further assessed.

中文翻译：

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用单极刀在盐溶液中进行水下内窥镜黏膜下剥离对结直肠肿瘤的作用（视频）

背景和目标

通常，大肠内窥镜黏膜下剥离术（ESD）是用单极刀从内窥镜供应CO ₂来进行的。关于用双极刀在盐溶液中进行水下ESD（UESD）的案例报道很少。用单极刀在盐溶液中使用UESD的有用性和安全性尚不清楚。本研究旨在探讨用单极刀在盐溶液中使用UESD对结直肠肿瘤的有效性和安全性。

方法

这项针对大肠肿瘤的UESD的回顾性观察研究包括2015年10月至2017年2月间在我科治疗的24例经UESD治疗的患者中的26例大肠肿瘤。患者的特征，与ESD困难相关的因素，治疗结果以及血液测试数据的差异对UESD之前和之后进行了分析。

结果

整块切除在所有病变中均成功，无任何严重不良事件。切除标本的中位大直径为30毫米（四分位间距[IQR]，28-35），肿瘤为22.5毫米（IQR，17.8-25.3）。中位手术时间为60分钟（IQR，45-111），解剖的中位速度为10.4 mm ² / min（IQR，6.4-12.2）。没有发生穿孔的情况。ESD后出血只有1例发生，并且实现了内镜止血。没有发生在UESD之后需要治疗的电解质失衡的情况。

结论

用单极刀在盐溶液中的UESD对于结直肠肿瘤是有用且安全的。UESD具有潜在优势，应进一步评估。