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首页> 外文期刊>Surgical Endoscopy >Endoscopic submucosal dissection with an additional working channel (ESD plus ): a novel technique to improve procedure time and safety of ESD
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Endoscopic submucosal dissection with an additional working channel (ESD plus ): a novel technique to improve procedure time and safety of ESD

机译：具有额外工作通道（ESD Plus）的内窥镜粘膜解剖：一种提高ESD的程序时间和安全的新技术

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Background and aims A new external additional working channel (AWC) was recently introduced by which endoscopic submucosal dissection (ESD) can be converted to a technique termed "ESD+ ". We aim to systematically evaluate this novel technique in flat gastric lesions and compare it to classical ESD. Methods The study was prospectively conducted in a pre-clinical ex vivo animal model (EASIE-R simulator) with porcine stomachs. Prior to intervention, we set standardized lesions measuring 3 cm or 4 cm in antegrade as well as in retrograde positions. Results Overall, 64 procedures were performed by an experienced endoscopist. Both techniques were reliable and showed en bloc resection rates of 100%. Overall, ESD+ reduced time of procedure compared to ESD (24.5 vs. 32.5 min,p = 0.025*). Particularly, ESD+ was significantly faster in retrograde lesions with a median of 22.5 vs. 34.0 min in 3 cm retrograde lesions (p = 0.002*) and 34.5 vs. 41.0 min (p = 0.011*) in 4 cm retrograde lesions. There were 0 perforations with both techniques. In ESD+ , 1 muscularis damage occurred (3.13%) compared to 6 muscularis damages with ESD (18.75%,p = 0.045*). Conclusions By its grasp-and-mobilize technique, ESD+ allows potentially faster and safer resections of flat gastric lesions compared to conventional ESD in an ex vivo porcine model. The potential advantages of ESD+ in terms of procedure time may be particularly relevant for difficult lesions in retrograde positions.
机译：背景与目的最近引入了一种新的外部附加工作通道（AWC），通过该通道可以将内镜粘膜下剥离（ESD）转换为一种称为“ESD+”的技术。我们的目的是系统地评估这种新技术在扁平胃病变中的应用，并将其与经典ESD进行比较。方法在临床前猪胃离体动物模型（EASIE-R模拟器）中进行前瞻性研究。在干预之前，我们将标准化病变设置为顺行和逆行位置的3厘米或4厘米。结果总的来说，64个手术由经验丰富的内窥镜医生执行。两种技术都是可靠的，整体切除率为100%。总的来说，与ESD相比，ESD+缩短了操作时间（24.5分钟对32.5分钟，p=0.025*）。特别是，ESD+在逆行性病变中显著更快，3cm逆行性病变的中位数分别为22.5分钟和34.0分钟（p=0.002*），4cm逆行性病变的中位数分别为34.5分钟和41.0分钟（p=0.011*）。两种技术都有0处穿孔。在ESD+中，发生1处肌层损伤（3.13%），而在ESD中发生6处肌层损伤（18.75%，p=0.045*）。结论在离体猪模型中，与传统的ESD相比，通过其抓取和移动技术，ESD+可以更快、更安全地切除扁平的胃病变。ESD+在手术时间方面的潜在优势可能与逆行位置的困难病变特别相关。

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