Endoscopic submucosal dissection using a carbon dioxide laser with submucosally injected laser absorber solution (porcine model)
Endoscopic submucosal dissection using a carbon dioxide laser with submucosally injected laser absorber solution (porcine model)
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DOI：
10.1007/s00464-013-3029-x
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发表时间：
2013-11-01
影响因子：
3.1
通讯作者：
Azuma, Takeshi
中科院分区：
文献类型：
--
作者：
Obata, Daisuke;Morita, Yoshinori;Azuma, Takeshi
近年来，内镜下粘膜剥离术（ESD）被用于治疗早期胃癌。有报道称，ESD的整体切除率高于常规内镜粘膜切除术（EMR），并且ESD可以切除比EMR更大的病变。然而，与传统EMR相比，ESD的并发症发生率更高。因此，需要开发能够提高ESD安全性的器件。激光作为一种可能的替代电手术工具已被广泛研究。然而，激光本身在照射胃肠道时容易造成穿孔。我们假设使用二氧化碳激光和粘膜下激光吸收器进行ESD治疗可能是一种安全、简单的早期胃癌治疗方法。为了证明使用二氧化碳激光器与粘膜下注射激光吸收剂溶液进行ESD的可行性，在猪模型上进行了离体和体内的实验研究。在切除的猪胃中使用二氧化碳（CO2）激光进行了五个内镜实验程序。此外，在生猪中使用CO2激光进行了三个内窥镜实验程序。在离体研究中，整体切除均无穿孔和肌肉损伤。此外，所有切除标本均可进行组织学评估。在体内研究中，在没有穿孔和肌肉损伤的情况下实现了整体切除，并且在手术过程中没有发生无法控制的出血。内镜下粘膜下夹层CO2激光联合粘膜下激光吸收器是治疗早期胃癌的一种可行、安全的方法。
Recently, endoscopic submucosal dissection (ESD) has been performed to treat early gastric cancer. The en bloc resection rate of ESD has been reported to be higher than that of conventional endoscopic mucosal resection (EMR), and ESD can resect larger lesions than EMR. However, ESD displays a higher complication rate than conventional EMR. Therefore, the development of devices that would increase the safety of ESD is desired. Lasers have been extensively studied as a possible alternative to electrosurgical tools. However, laser by itself easily resulted in perforation upon irradiation of the gastrointestinal tract. We hypothesized that performing ESD using a CO2 laser with a submucosal laser absorber could be a safe and simple treatment for early gastric cancer. To provide proof of concept regarding the feasibility of ESD using a CO2 laser with submucosally injected laser absorber solution, an experimental study in ex vivo and in vivo porcine models was performed.Five endoscopic experimental procedures using a carbon dioxide (CO2) laser were performed in a resected porcine stomach. In addition, three endoscopic experimental procedures using a CO2 laser were performed in living pigs.In the ex vivo study, en bloc resections were all achieved without perforation and muscular damage. In addition, histological evaluations could be performed in all of the resected specimens. In the in vivo study, en bloc resections were achieved without perforation and muscular damage, and uncontrollable hemorrhage did not occur during the procedures.Endoscopic submucosal dissection using a CO2 laser with a submucosal laser absorber is a feasible and safe method for the treatment of early gastric cancer.