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首页> 外文期刊>Surgical Endoscopy >Double-clip traction could be superior to the pocket-creation method with cylindrical cap for colonic ESD: a randomized study in an ex vivo model
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Double-clip traction could be superior to the pocket-creation method with cylindrical cap for colonic ESD: a randomized study in an ex vivo model

机译：双夹牵引力可以优于具有圆柱形盖的口袋制作方法，用于结肠ESD：在前体内模型中的随机研究

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摘要

Introduction In Western countries, debates between ESD vs piece-meal EMR as the best treatment for large colorectal adenomas persist regarding the difficulty of ESD the colon, and the safety and relatively good results of piece-meal endoscopic mucosal resection (EMR). Pocket-creation method (PCM) and double-clip countertraction (DCT) are two strategies recently published to facilitate ESD in this challenging situation. Method This is a randomized animal study to compare PCM and DCT strategies for colonic ESD on ex vivo models (bovine colon) performed by 3 operators novice in ESD. Hybridknife type T was used to inject normal saline tinted with a small amount of blue dye in all procedures. Randomization was stratified according to the use of gravity assist. Primary endpoint was the difference in resection speed between PCM and DCT strategies. Results Resection speed was significantly higher in the DCT group than in the PCM group (56.3 vs. 31.6 mm(2)/min, p = 0.01). Technical success rate, defined as en bloc resection in under 60 min, was significantly better in the DCT group than in the PCM group (100% vs. 84.4%, p = 0.024), perforation rate was lower (0% vs. 18.8%, p = 0.012), and difficulty score was better (2.4 vs. 6.2, p < 0.0001) as was procedure duration (24.2 vs. 40.2 min, p < 0.0001). Conclusion DCT was superior to PCM for ESD in our validated bovine colon model. This strategy is inexpensive, easy to use and adaptive. It might facilitate the widespread use of colonic ESD in Western countries and change Western ideas regarding the use of colonic ESD compared with piece-meal EMR for large benign lesions.
机译：导言在西方国家，关于ESD在结肠内的难度，以及片式内镜黏膜切除术（EMR）的安全性和相对良好的结果，ESD与片式EMR作为大型大肠腺瘤最佳治疗方法之间的争论仍然存在。口袋创建方法（PCM）和双夹反牵引（DCT）是最近发布的两种策略，旨在在这种具有挑战性的情况下促进ESD。方法这是一项随机动物研究，比较3名ESD新手在离体模型（牛结肠）上对结肠ESD的PCM和DCT策略。在所有操作中，使用T型杂交刀注射少量蓝色染料染色的生理盐水。根据重力辅助的使用情况进行随机分层。主要终点是PCM和DCT策略之间切除速度的差异。结果DCT组的切除速度明显高于PCM组（56.3 vs.31.6 mm（2）/min，p=0.01）。DCT组的技术成功率（定义为60分钟内整块切除）明显优于PCM组（100%对84.4%，p=0.024），穿孔率较低（0%对18.8%，p=0.012），难度评分更好（2.4对6.2，p<0.0001），手术持续时间（24.2对40.2分钟，p<0.0001）。结论在我们验证的牛结肠模型中，DCT优于PCM。这种策略成本低，易于使用，而且适应性强。这可能会促进结肠ESD在西方国家的广泛使用，并改变西方关于结肠ESD与大块EMR相比用于大型良性病变的观念。

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  • 来源
    《Surgical Endoscopy》 |2021年第3期|共10页
  • 作者

    Albouys Jeremie; Dahan Martin; Lepetit Hugo; Charissoux Aurelie; Guyot Anne; Pioche Mathieu; Legros Romain; Carrier Paul; Loustaud-Ratti Veronique; Geyl Sophie; Jacques Jeremie;

  • 作者单位

    CHU Dupuytren Serv Hepatogastroenterol 2 Ave Martin Luther King F-87042 Limoges France;

    CHU Dupuytren Serv Hepatogastroenterol 2 Ave Martin Luther King F-87042 Limoges France;

    CHU Dupuytren Serv Hepatogastroenterol 2 Ave Martin Luther King F-87042 Limoges France;

    CHU Dupuytren Serv Anatomopathol 2 Ave Martin Luther King F-87042 Limoges France;

    CHU Dupuytren Serv Anatomopathol 2 Ave Martin Luther King F-87042 Limoges France;

    Hosp Civils Lyon Serv Hepatogastroenterol Hop Edouard Herriot F-69003 Lyon France;

    CHU Dupuytren Serv Hepatogastroenterol 2 Ave Martin Luther King F-87042 Limoges France;

    CHU Dupuytren Serv Hepatogastroenterol 2 Ave Martin Luther King F-87042 Limoges France;

    CHU Dupuytren Serv Hepatogastroenterol 2 Ave Martin Luther King F-87042 Limoges France;

    CHU Dupuytren Serv Hepatogastroenterol 2 Ave Martin Luther King F-87042 Limoges France;

    CHU Dupuytren Serv Hepatogastroenterol 2 Ave Martin Luther King F-87042 Limoges France;

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  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 诊断学;
  • 关键词

    ESD; Colorectal; Pocket; Traction; Ex vivo; Training;

    机译：静电放电;结直肠;衣袋牵引离体;训练;

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