Prospective, randomized comparison of a prototype endoscope with deflecting working channels versus a conventional double-channel endoscope for rectal endoscopic submucosal dissection in an established experimental simulation model (with video)
Prospective, randomized comparison of a prototype endoscope with deflecting working channels versus a conventional double-channel endoscope for rectal endoscopic submucosal dissection in an established experimental simulation model (with video)
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DOI：
10.1016/j.gie.2013.04.193
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发表时间：
2013-11-01
影响因子：
7.7
通讯作者：
Matthes, Kai
中科院分区：
文献类型：
--
作者：
Jung, Yunho;Kato, Masayuki;Matthes, Kai
背景资料：设计了一种原型内窥镜，通过使用具有不同偏转的2个工作通道来改善组织的可视化和剥离。目的：评价原型内窥镜与传统双通道内窥镜相比用于直肠内窥镜粘膜下剥离术（ESD）的有效性和可操作性。设计：随机、前瞻性、对照、离体研究。设置：学术医学中心。方法：在离体新鲜猪结直肠标本中，在距肛缘约5 cm处共创建了80个3 x 3 cm的标准化人工病变。两名内镜医师分别完成20例原型内镜和20例传统内镜。主要结果测量：一名独立观察者记录手术时间、标本大小、整块切除和穿孔率。与传统组相比，原型组的手术时间（10.5 +/- 3.8 vs 14.9 +/- 7.3分钟; P = 0.024）和总手术时间（18.1 +/- 5.2 vs 23.6 +/- 8.2分钟; P = 0.015）显著缩短。对于ESD专家，平均环形切除、粘膜下剥离和总手术时间之间无显著差异（原型组14.2 +/- 6.0分钟，传统组14.2 +/- 8.8分钟; P = 0.992）。整体穿孔和整块切除率并没有显着不同groups.Limitations：离体study.Conclusion：在这个离体前瞻性比较研究，有一个技术优势，为ESD新手与原型内窥镜，导致在较短的手术时间，这是没有观察到的情况下，由ESD专家进行。
Background: A prototype endoscope was designed to improve visualization and dissection of tissue with the use of 2 working channels with different deflections.Objective: To evaluate the efficacy and operability of a prototype endoscope in comparison with a conventional double-channel endoscope for rectal endoscopic submucosal dissection (ESD).Design: Randomized, prospective, controlled, ex vivo study.Setting: Academic medical center.Methods: A total of 80 standardized artificial lesions measuring 3 x 3 cm were created approximately 5 cm from the anal verge in fresh ex vivo porcine colorectal specimens. Two endoscopists each completed 20 cases with the prototype endoscope and 20 cases with the conventional endoscope.Main Outcome Measurements: An independent observer recorded procedure time, specimen size, en bloc resection, and perforation rate.Results: For the ESD novice, the mean submucosal dissection time (10.5 +/- 3.8 vs 14.9 +/- 7.3 minutes; P = .024) and total procedure time (18.1 +/- 5.2 vs 23.6 +/- 8.2 minutes; P = .015) were significantly shorter in the prototype group in comparison with the conventional group. For the ESD expert, there was no significant difference between the mean circumferential resection, submucosal dissection, and total procedure time (prototype group 14.2 +/- 6.0 minutes, conventional group 14.2 +/- 8.8 minutes; P = .992). The overall perforation and en bloc resection rates were not significantly different between groups.Limitations: Ex vivo study.Conclusion: In this ex vivo prospective comparison study, there was a technical advantage for the ESD novice with the prototype endoscope that resulted in a shorter procedure time, which was not observed for cases performed by the ESD expert.