The pocket-creation method facilitates colonic endoscopic submucosal dissection (with video),Gastrointestinal Endoscopy

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The pocket-creation method facilitates colonic endoscopic submucosal dissection (with video)
Gastrointestinal Endoscopy ( IF 6.7 ) Pub Date : 2019-02-01 , DOI: 10.1016/j.gie.2019.01.022
Takahito Takezawa , Yoshikazu Hayashi , Satoshi Shinozaki , Yuichi Sagara , Masahiro Okada , Yasutoshi Kobayashi , Hirotsugu Sakamoto , Yoshimasa Miura , Keijiro Sunada , Alan Kawarai Lefor , Hironori Yamamoto

Background and Aims

Colonic endoscopic submucosal dissection (ESD) is more difficult than rectal ESD because of poor maneuverability of the endoscope due to physiologic flexion, peristalsis, and respiratory movements. The aim of this study was to assess the usefulness of the pocket-creation method (PCM) for colonic ESD compared with the conventional method (CM) regardless of lesion shape or location.

Methods

A total of 887 colorectal lesions were treated by ESD. Of 887 lesions, 271 rectal lesions, 72 lesions smaller than 20 mm in diameter, and 1 non-neoplastic lesion were excluded. This is a retrospective chart review of the remaining 543 colon lesions in 512 patients. We divided them into the PCM group (n = 280) and the CM group (n = 263). The primary outcome was the en bloc resection rate. Secondary outcomes were R0 resection (en bloc resection with negative margin), adverse events, dissection time (in minutes), and dissection speed (in mm²/min).

Results

The PCM group achieved a significantly higher en bloc resection rate (PCM, 100% [280/280], vs CM, 96% [253/263]; P < .001) and R0 resection rate (91% [255/280] vs 85% [224/263], respectively; P = .033) than the CM group. Dissection time was similar (69.5 ± 44.4 vs 78.7 ± 62.6 minutes, P = .676). Dissection speed was significantly faster with the PCM than with the CM (23.5 ± 11.6 vs 20.9 ± 13.6 mm²/min, P < .001). The incidence of adverse events was similar (perforation, 2% vs 4% [P = .152], and delayed bleeding, 2% vs 1% [P = .361]).

Conclusions

Colonic ESD using the PCM significantly improves the rates of en bloc resection and R0 resection and facilitates rapid dissection.

中文翻译：

袋式创建方法有助于结肠内窥镜下黏膜下剥离（附视频）

背景和目标

结肠内窥镜黏膜下剥离术（ESD）比直肠ESD更难，因为由于生理弯曲，蠕动和呼吸运动导致内窥镜操作性差。这项研究的目的是评估与传统方法（CM）相比，无论病变的形状或位置如何，袋式创建方法（PCM）对结肠ESD的有用性。

方法

ESD治疗了总共887个大肠病变。在887个病变中，排除了271个直肠病变，72个直径小于20 mm的病变和1个非肿瘤性病变。这是对512例患者中其余543例结肠病变的回顾性图表回顾。我们将它们分为PCM组（n = 280）和CM组（n = 263）。主要结果是整体切除率。次要结果为R0切除术（整块切除术带负切缘），不良事件，解剖时间（以分钟为单位）和解剖速度（以mm ² / min为单位）。

结果

PCM组的整体切除率显着提高（PCM，100％[280/280]，而CM，96％[253/263]；P <.001）和R0切除率（91％[255/280]）分别比CM组高85％[224/263]；P = .033）。解剖时间相似（69.5±44.4 vs 78.7±62.6分钟，P = .676）。PCM的解剖速度明显快于CM（23.5±11.6 vs 20.9±13.6 mm ² / min，P <.001）。不良事件的发生率相似（穿孔率为2％vs 4％[ P = .152]，延迟出血为2％vs 1％[ P = .361]）。