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首页> 外文期刊>Surgical Endoscopy >Effectiveness and safety of underwater techniques in gastrointestinal endoscopy: a comprehensive review of the literature
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Effectiveness and safety of underwater techniques in gastrointestinal endoscopy: a comprehensive review of the literature

机译：胃肠内窥镜检查中水下技术的有效性和安全性：对文学的全面综述

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Background Conventional endoscopic resection techniques such as endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD), represent the standard of care for treatment of superficial gastrointestinal lesions. In 2012 a novel technique called underwater endoscopic mucosal resection (U-EMR) was described by Binmoeller and colleagues. This substantial variation from the standard procedure was afterwards applied at endoscopic submucosal dissection (U-ESD) and recently proposed also for peroral endoscopic myotomy (U-POEM) and endoscopic full-thickness resection (U-EFTR). Methods This paper aims to perform a comprehensive review of the current literature related to supporting the underwater resection techniques with the aim to evaluate their safety and efficacy. Results Based on the current literature U-EMR appears to be feasible and safe. Comparison studies showed that U-EMR is associated with higher "en-bloc" and R0 resection rates for colonic lesions, but lower "en-bloc" and R0 resection rates for duodenal non-ampullary lesions, compared to standard EMR. In contrast to U-EMR, little evidence supporting U-ESD are currently available. A single comparison study on gastric lesions showed that U-ESD had shorter procedural times and allowed a similar "en-bloc" resection rates compared to standard ESD. No comparison studies between U-ESD and ESD are available for colonic lesions. Finally, only some anecdotal experiences have been reported for U-POEM or U-EFTR, and the feasibility and effectiveness of these techniques need to be further investigated. Conclusions Further prospective studies are necessary to better explore the advantages of underwater techniques compared to the respective standards of care, especially in the setting of U-ESD where consistent data are lacking and where standardization of the technique is needed.
机译：背景传统的内镜切除技术，如内镜黏膜切除术（EMR）或内镜黏膜下剥离术（ESD），代表了浅表性胃肠道病变治疗的标准。2012年，宾默勒及其同事介绍了一种称为水下内镜粘膜切除术（U-EMR）的新技术。这种与标准程序的实质性差异后来被应用于内镜黏膜下剥离术（U-ESD），最近也被提议用于经口内镜肌切开术（U-POME）和内镜全层切除术（U-EFTR）。方法本文旨在对目前与支持水下切除术相关的文献进行全面回顾，以评估其安全性和有效性。根据现有文献的结果，U-EMR似乎是可行和安全的。对比研究表明，U-EMR与标准EMR相比，结肠病变的“整块”和R0切除率较高，但十二指肠非壶腹病变的“整块”和R0切除率较低。与U-EMR相比，目前几乎没有证据支持U-ESD。一项关于胃病变的单一对比研究表明，U-ESD的手术时间较短，与标准ESD相比，其“整体”切除率相似。对于结肠病变，U-ESD和ESD之间没有比较研究。最后，关于U-POME或U-EFTR，只有一些轶事经验被报道，这些技术的可行性和有效性还需要进一步研究。结论有必要进行进一步的前瞻性研究，以更好地探索水下技术与相应护理标准相比的优势，尤其是在U-ESD设置中，缺乏一致的数据，需要对技术进行标准化。

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