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Over-the-scope clip-assisted endoscopic full thickness resection: a video-based case series.
Surgical Endoscopy ( IF 2.4 ) Pub Date : 2020-03-18 , DOI: 10.1007/s00464-020-07481-z
Shou-Jiang Tang 1 , Yehia M Naga 1 , Ruonan Wu 1 , Shengyu Zhang 2
Affiliation  

BACKGROUND In the management of mucosal neoplasm and early cancer, therapeutic gastrointestinal endoscopy evolved from simply polypectomy, endoscopic mucosal resection, endoscopic submucosal dissection (ESD), to endoscopic full thickness resection (EFTR). Full thickness clip closure followed by transmural resection mimics surgical principles. It is safe, effective, and technically less demanding compared to other techniques. Over-the-scope clip (OTSC)-assisted EFTR or OTSC-EFTR enables the endoscopists to manage difficult lesions. METHODS We video recorded and report our 1-year single center experience of 12 consecutive EFTR cases since the dedicated OTSC-EFTR device was approved in the USA. RESULTS We demonstrate that OTSC-EFTR can be very useful to manage residual neoplastic tissue that cannot be removed during conventional mucosal resection due to deeper invasion, submucosal fibrosis, scaring from prior intervention, and appendiceal involvement. Caution should be used for EFTR of the ileocecal valve lesions. CONCLUSION We propose that layered or stacked biopsy of the appendiceal stump after EFTR should be performed to rule out a positive residual base. Due to the limited size of the FTRD resection hood (13 mm internal diameter × 23 mm depth), for larger sessile adenomas in the colon, we propose a hybrid approach for complete removal: piecemeal EMR for tumor debulking followed by OTSC-EFTR to achieve R0 resection. We believe OTSC-EFTR offers safety and efficiency with very high success rate.

中文翻译:

镜夹辅助内窥镜全厚度切除术:基于视频的病例系列。

背景技术在粘膜肿瘤和早期癌症的治疗中,治疗性胃肠道内窥镜从单纯的息肉切除术,内窥镜黏膜切除术,内窥镜黏膜下剥离术(ESD)发展到内窥镜全厚度切除术(EFTR)。全厚度夹子闭合后进行透壁切除术模仿了手术原理。与其他技术相比,它安全,有效且在技术上要求较低。借助镜夹(OTSC)辅助的EFTR或OTSC-EFTR,内窥镜医师可以处理困难的病变。方法自从专用OTSC-EFTR设备在美国获得批准以来,我们录制了视频并报告了我们12年连续EFTR病例在单中心的一年经验。结果我们证明,OTSC-EFTR对于处理残留的赘生性组织非常有用,这些赘生性组织由于较深的浸润,粘膜下纤维化,先前介入引起的惊吓和阑尾受累而无法在常规粘膜切除术中切除。对回盲瓣膜病变的EFTR应谨慎。结论我们建议对EFTR后的阑尾残端进行分层或堆叠活检,以排除残留阳性。由于FTRD切除罩的尺寸有限(内径13毫米×深度23毫米深),对于结肠中较大的无蒂腺瘤,我们提出了一种完全切除的混合方法:逐块EMR切除肿瘤,然后通过OTSC-EFTR实现R0切除。我们相信OTSC-EFTR具有很高的成功率,可提供安全性和效率。粘膜下纤维化,先前干预引起的惊吓和阑尾受累。对回盲瓣膜病变的EFTR应谨慎。结论我们建议对EFTR后的阑尾残端进行分层或堆叠活检,以排除残留阳性。由于FTRD切除罩的尺寸有限(内径13毫米×深度23毫米深),对于结肠中较大的无蒂腺瘤,我们提出了一种完全切除的混合方法:逐块EMR切除肿瘤,然后通过OTSC-EFTR实现R0切除。我们相信OTSC-EFTR具有很高的成功率,可提供安全性和效率。粘膜下纤维化,先前干预引起的恐惧和阑尾受累。对回盲瓣膜病变的EFTR应谨慎。结论我们建议对EFTR后的阑尾残端进行分层或堆叠活检,以排除残留残基阳性。由于FTRD切除罩的尺寸有限(内径13毫米×深度23毫米深),对于结肠中较大的无蒂腺瘤,我们提出了一种完全切除的混合方法:逐块EMR切除肿瘤,然后通过OTSC-EFTR实现R0切除。我们相信OTSC-EFTR具有很高的成功率,可提供安全性和效率。结论我们建议对EFTR后的阑尾残端进行分层或堆叠活检,以排除残留阳性。由于FTRD切除罩的尺寸有限(内径13毫米×深度23毫米深),对于结肠中较大的无蒂腺瘤,我们提出了一种完全切除的混合方法:逐块EMR切除肿瘤,然后通过OTSC-EFTR实现R0切除。我们相信OTSC-EFTR具有很高的成功率,可提供安全性和效率。结论我们建议对EFTR后的阑尾残端进行分层或堆叠活检,以排除残留残基阳性。由于FTRD切除罩的尺寸有限(内径13毫米×深度23毫米深),对于结肠中较大的无蒂腺瘤,我们提出了一种完全切除的混合方法:逐块EMR切除肿瘤,然后通过OTSC-EFTR实现R0切除。我们相信OTSC-EFTR具有很高的成功率,可提供安全性和效率。
更新日期:2020-03-19
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