Facilitating endoscopic submucosal dissection: double balloon endolumenal platform significantly improves dissection time compared with conventional technique (with video).
Facilitating endoscopic submucosal dissection: double balloon endolumenal platform significantly improves dissection time compared with conventional technique (with video).
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DOI：
10.1007/s00464-018-6336-4
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发表时间：
2019-01
期刊：
影响因子：
--
通讯作者：
Milsom J
中科院分区：
文献类型：
--
作者：
Sharma S;Momose K;Hara H;East J;Sumiyama K;Nakajima K;Silbehumer G;Milsom J
柔性内窥镜操纵肠道环境的能力是有限的。因此，复杂的腔内手术往往技术要求高，手术时间长，影响机构资源。单球囊和双球囊附加内窥镜装置已在整个胃肠道中使用，以促进组织控制，例如小肠肠镜检查，最近的报告表明可能在结肠中用于复杂的手术，例如 ESD。我们的目标是客观地分析新型双球囊装置在执行 ESD 方面的功效。离体 — 使用标准 40 毫米直径模板在猪直肠中创建 12 个模拟结肠病变。评估了两个类别：标准帽技术 ESD 和双球囊辅助回缩 ESD (ESD-R)。病例按顺序进行。体内——在猪模型中进行了六个 40 毫米病变 ESD-R。本研究的主要结果是总手术时间和解剖时间。在离体研究中，双球囊平台的中位总手术时间明显短于传统 ESD 技术（29±18 分钟与 57±21 分钟，p=0.03）。在体内研究中，病灶平均在 48 分钟内成功切除，解剖时间为 20 分钟，没有明显并发症。在所有双球囊辅助病例中都使用了球囊夹回缩和标本检索功能。 6 例后，时间明显缩短（离体 47 分钟 vs. 17 分钟；体内 57 分钟 vs. 27 分钟）。我们已经展示了由新型双气球装置促进的独特技术 ESD 方法的开发。离体和体内研究表明 ESD-R 优于传统的离体方法。 DB 装置提高了稳定性、改善了可视化和组织牵引，从而显着缩短了解剖时间。这种方法可以提高安全性，改善患者的治疗效果，并可以防止因良性病症而进行不必要的手术。本文的在线版本 (10.1007/s00464-018-6336-4) 包含补充材料，可供授权用户使用。
Flexible endoscopes ability to manipulate the intestinal environment is limited. As a result, complex endolumenal procedures are often technically demanding and result in long procedure times, impacting institutional resources. Single- and double-balloon add-on endoscopic devices have been employed throughout the GI tract to facilitate tissue control e.g., small bowel enteroscopy, with recent reports suggesting a possible colonic utility for complex procedures e.g., ESD. Our objective was to objectively analyze the efficacy of a new double-balloon device in performing ESD. Ex vivo—12 simulated colonic lesions were created in porcine rectum using a standard 40 mm diameter template. Two categories were evaluated, standard cap technique ESD and double-balloon assisted ESD with retraction (ESD-R). Cases were performed sequentially. In vivo—Six, 40 mm lesion ESD-R’s were performed in a porcine model. The primary outcomes of this study were total procedure and dissection times. In ex vivo studies, the median total procedure time with the double-balloon platform was significantly shorter than the traditional ESD technique (29 ± 18 vs. 57 ± 21 min, p = 0.03). In the in vivo studies, lesions were successfully removed in a mean time of 48 min, with a dissection time of 20 min with no significant complications. Balloon-clip retraction and specimen retrieval capabilities were used in all double-balloon assisted cases. After 6 cases, times were significantly shorter (ex vivo 47 vs. 17 min; in vivo 57 vs. 27 min). We have demonstrated the development of a unique technical ESD method facilitated by a new double-balloon device. Ex and in vivo investigation demonstrated superiority of ESD-R over the conventional ex vivo method. The DB device provided increased stability, improved visualization and tissue traction, which significantly reduced dissection time. Such an approach may increase safety, improve patient outcomes, and may prevent unnecessary surgeries for benign conditions. The online version of this article (10.1007/s00464-018-6336-4) contains supplementary material, which is available to authorized users.
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影响因子：
7.7
作者：
Miller, K;Waye, JD
通讯作者：
Waye, JD
影响因子：
12.6
作者：
Overhiser, Andrew J.;Rex, Douglas K.
通讯作者：
Rex, Douglas K.
影响因子：
7.7
作者：
Nelson, DB;Block, KP;Wang, KK
通讯作者：
Wang, KK
DOI：
10.1007/s00464-011-2075-5
发表时间：
2012-06-01
影响因子：
3.1
作者：
Lee, Eun-Jung;Lee, Jae Bum;Youk, Eui Gon
通讯作者：
Youk, Eui Gon
影响因子：
--
作者：
Riff, Brian P;DiMaio, Christopher J
通讯作者：
DiMaio, Christopher J