Optimized hybrid endoscopic submucosal dissection for colorectal tumors: a randomized controlled trial
Optimized hybrid endoscopic submucosal dissection for colorectal tumors: a randomized controlled trial
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DOI：
10.1016/j.gie.2015.06.057
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发表时间：
2016-03-01
影响因子：
7.7
通讯作者：
Byeon, Jeong-Sik
中科院分区：
文献类型：
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作者：
Bae, Jung Ho;Yang, Dong-Hoon;Byeon, Jeong-Sik
背景和目的：结直肠内镜下粘膜下剥离术（ESD）困难且耗时。使用圈套器优化ESD（优化的混合ESD）可缩短手术时间。本研究的目的是前瞻性比较ESD和优化的混合ESD在colorectal.Methods：我们前瞻性纳入70例结直肠肿瘤>= 20 mm.患者随机接受ESD（36例）或优化的混合ESD（34例）。在优化的混合ESD组中，在足够量的粘膜下剥离后进行圈套器切除。主要结局是手术时间。次要结果是整块和完全切除率和不良事件rates.Results：ESD不能完成5例（13.9%）在ESD组，因为技术上的困难。我们尝试了混合ESD完成切除，4例患者（80%）实现了整块切除。优化混合ESD组的平均手术时间短于ESD组（27.4 vs 40.6分钟; P =. 005）。整块切除率相似（94.1% vs 100%; P =.完全切除率（91.2% vs 93.5%; P > 0.999）和穿孔率（3例患者[8.8%] vs 2例患者[6.5%]; P > 0.999）。结论：优化的混合ESD比ESD手术时间更短，整体切除率和不良事件发生率相似。优化的混合ESD在结直肠可能提供一个简单的替代结直肠ESD和失败的ESD病例的抢救方法。
Background and Aims: Colorectal endoscopic submucosal dissection (ESD) is difficult and time consuming. Optimization of ESD with snaring (optimized hybrid ESD) may shorten the procedure time. The purpose of this study was to prospectively compare ESD and optimized hybrid ESD in the colorectum.Methods: We prospectively enrolled 70 patients with colorectal neoplasia >= 20 mm. The patients were randomized to receive either ESD (36 patients) or optimized hybrid ESD (34 patients). In the optimized hybrid ESD group, snare resection was performed after an adequate amount of submucosal dissection. The primary outcome was procedure time. Secondary outcomes were en bloc and complete resection rates and adverse event rates.Results: ESD could not be completed in 5 patients (13.9%) in the ESD group because of technical difficulties. We tried hybrid ESD to finish the resection, and en bloc resection was achieved in 4 patients (80%). The mean procedure time was shorter in the optimized hybrid ESD group compared with the ESD group (27.4 vs 40.6 minutes; P =. 005). The en bloc resection rates were similar (94.1% vs 100%; P =. 493), as were the complete resection rates (91.2% vs 93.5%; P >.999) and perforation rates (3 patients [8.8%] vs 2 patients [6.5%]; P >.999).Conclusions: Optimized hybrid ESD achieves shorter procedure times than ESD, with similar en bloc resection rates and adverse event rates. Optimized hybrid ESD in the colorectum may offer an easy alternative to colorectal ESD and a rescue method for failed ESD cases.