Use of a novel endoscopic overtube with bilateral tool channels for endoscopic resection of experimental lesions and repair of intestinal defects in the right colon: preclinical trial
Use of a novel endoscopic overtube with bilateral tool channels for endoscopic resection of experimental lesions and repair of intestinal defects in the right colon: preclinical trial
复制标题
DOI：
10.1007/s00464-022-09637-5
复制
发表时间：
2022-10-11
影响因子：
3.1
通讯作者：
Milsom，Jeffrey W.
中科院分区：
文献类型：
--
作者：
Urakawa，Shinya;Hirashita，Teijiro;Milsom，Jeffrey W.
背景内窥镜肿瘤切除和肠道缺损修复在技术上具有挑战性，导致需要进行侵入性手术和结肠切除术来切除良性息肉。在这项研究中，我们评估了带有双侧工具通道的内窥镜外套管在这些手术中的使用。方法在 3D 离体模型中使用新鲜的猪结肠直肠，通过两种不同的技术切除横结肠后壁的 3 cm 病变：标准内镜粘膜下剥离 (ESD) 技术 (STD,n= 12) 和使用带有内窥镜圈套器和抓紧器的外套管通过双侧通道进行 ESD (OT,n= 12)。评估手术时间和肌肉损伤的数量。使用相同的模型，通过两种不同的技术闭合横结肠后壁 3 cm 粘膜缺损内的 5–10 mm 全层穿孔：标准内镜闭合技术 (STD,n= 12) 和使用带有两个抓手的外管的内镜闭合技术 (OT,n= 12)。测量的结果包括破裂压力和用于闭合的内窥镜夹的数量。 结果与 OT 组相比，OT 组进行病灶内镜切除术的总手术时间显着缩短（STD vs. OT = 中位数 38.9 分钟 vs. 17.3，p< 0.001），并且肌肉损伤较少（中位数 0 vs. 2，p= 0.002）。性病组。肠道缺陷修复后，尽管使用的夹子较少（中位 13 比 10，p< 0.001），OT 组仍表现出较高的中位爆破压（STD vs. OT = 11.2 mmHg vs. 57.1，p= 0.008）。结论本研究展示了一种新型牵引技术，使用内窥镜外管使用多种器械去除病变并修复结肠中的肠道缺陷有效地。该内窥镜平台可以为侵入性手术治疗提供安全的替代方案。
BackgroundEndoscopic tumor resection and intestinal defect repair are technically challenging leading to invasive surgery and colectomy performed for resection of benign polyps. In this study, we evaluated the use of an endoscopic overtube with bilateral tool channels for these procedures.MethodsUsing a fresh porcine colorectum in a 3D ex vivo model, 3 cm lesions at the posterior wall of the transverse colon were removed by two different techniques: standard endoscopic submucosal dissection (ESD) technique (STD,n= 12) and ESD using the overtube with an endoscopic snare and grasper through the bilateral channels (OT,n= 12). Procedure times and the number of muscular injuries were evaluated. Using the same model, 5–10 mm full-thickness perforations within a 3 cm mucosal defect at the posterior wall of the transverse colon were closed by two different techniques: standard endoscopic closure technique (STD,n= 12) and endoscopic closure using the overtube with two graspers (OT,n= 12). The outcomes measured included bursting pressure and the number of endoscopic clips used for closure.ResultsEndoscopic resection of lesions was performed by the OT group in a significantly shorter total procedure time (STD vs. OT = median 38.9 min vs. 17.3,p< 0.001) and with fewer muscular injuries (median 0 vs. 2,p= 0.002), compared with the STD group. After repair of intestinal defects, the OT group showed higher median bursting pressures (STD vs. OT = 11.2 mmHg vs. 57.1,p= 0.008) despite using fewer clips (median 13 vs. 10,p< 0.001).ConclusionThis study demonstrates a novel traction technique with an endoscopic overtube using multiple instruments to remove lesions and repair intestinal defects in the colon more effectively. This endoscopic platform could provide a safe alternative to invasive surgical treatment.