Feasibility of a new ligation using the double-loop clips technique without an adhesive agent for ulceration after endoscopic submucosal dissection of the colon (with video).,Gastrointestinal Endoscopy

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Feasibility of a new ligation using the double-loop clips technique without an adhesive agent for ulceration after endoscopic submucosal dissection of the colon (with video).
Gastrointestinal Endoscopy ( IF 6.7 ) Pub Date : 2020-02-20 , DOI: 10.1016/j.gie.2020.02.015
Satoshi Abiko ₁ , Sonoe Yoshida ₁ , Ayumu Yoshikawa ₁ , Kazuaki Harada ₁ , Naoki Kawagishi ₁ , Itsuki Sano ₁ , Hisashi Oda ₁ , Takuto Miyagishima ₁

Affiliation

Background and Aims

Several ligation techniques for ulceration after endoscopic submucosal dissection (ESD) have been reported, but none have been established for clinical use because of technical complexity and the need for expensive equipment. Therefore, the technical feasibility of a new ligation method using the double-loop clips (D-L clips) technique without an adhesive agent for ulceration after ESD of the colon was assessed.

Methods

Among 35 patients who underwent ESD of the colon in Kushiro Rosai Hospital between April 2019 and September 2019, 26 patients who underwent ligation using the D-L clips technique for the post-ESD ulcer bed were included in this retrospective study. Continuation or cessation of antithrombotic agents was based on the Guidelines for Gastroenterological Endoscopy in Patients Undergoing Antithrombotic Treatment.

Results

The rate of en bloc R0 resection was 97.1%, the median length of the resected specimen was 3.2 cm (interquartile range [IQR], 2.8-3.8 cm), and the complete ligation rate was 88.5% (23 of 26). Excluding patients with lesion sites in the rectum below the peritoneal reflection, the complete ligation rate was 95.5% (21 of 22). The median duration of the ligation procedure was 20 minutes (IQR, 16-24 minutes). The only delayed procedural adverse event was post-ESD coagulation syndrome in 1 patient. Incomplete ligation was significantly more frequent in patients with lesion sites in the inferior rectal valve/anal verge area (P = .0269).

Conclusions

Ligation using the D-L clips technique without an adhesive agent is feasible for closing ulceration after ESD of the colon, whereas other techniques may be necessary for lesions in the rectum below the peritoneal reflection.

中文翻译：

使用双环夹子技术在不使用粘合剂的情况下进行新的结扎术以内窥镜检查结肠黏膜下剥离后溃疡的可行性（带视频）。

背景和目标

内镜下黏膜下剥离术（ESD）后溃疡的几种结扎技术已有报道，但由于技术复杂和对昂贵设备的需求，尚未建立用于临床的结扎技术。因此，评估了一种新的结扎方法的技术可行性，该方法使用了不使用粘合剂的双环夹子（DL夹子）技术来结肠结肠ESD后溃疡。

方法

在这项回顾性研究中，于2019年4月至2019年9月在Ku路罗萨医院接受结肠ESD治疗的35例患者中，有26例使用DL夹技术进行ESD后溃疡床结扎的患者包括在内。抗血栓药的继续或停用是基于接受抗血栓治疗的患者的肠胃镜检查指南。

结果

整体R0切除率为97.1％，切除标本的中位长度为3.2 cm（四分位间距[IQR]，2.8-3.8 cm），完全结扎率为88.5％（26中的23）。排除腹膜反射以下直肠病变部位的患者，完全结扎率为95.5％（22中的21）。结扎过程的中位时间为20分钟（IQR，16-24分钟）。唯一延迟的手术不良事件是1例患者的ESD后凝血综合征。在直肠下瓣膜/肛门边缘区域有病变部位的患者中，不完全结扎的发生率明显更高（P = .0269）。