Successful outcomes of a novel endoscopic treatment for GI tumors: endoscopic submucosal dissection with a mixture of high-molecular-weight hyaluronic acid, glycerin, and sugar
Successful outcomes of a novel endoscopic treatment for GI tumors: endoscopic submucosal dissection with a mixture of high-molecular-weight hyaluronic acid, glycerin, and sugar
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DOI：
10.1016/j.gie.2005.08.002
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发表时间：
2006-02-01
影响因子：
7.7
通讯作者：
Omata, M
中科院分区：
文献类型：
--
作者：
Fujishiro, M;Yahagi, N;Omata, M
背景资料：内镜粘膜下剥离术（ESD）最近已发展用于胃肠道肿瘤的内镜治疗，这使得LI能够整块切除甚至较大的肿瘤。然而，相当频繁的穿孔已经成为另一个问题。预防穿孔的最佳方法是建立足够的粘膜下液垫（SFC）。本研究的目的是通过使用1900 KDa透明质酸（Suvenyl）和10%甘油加5%果糖溶液（Glyceol）的混合物来寻找ESD的可行性。Suvenyl和Glyceol的混合比例对于食管/结直肠肿瘤和有I型瘢痕的胃肿瘤为1：3，对于无瘢痕的胃肿瘤为1：7。建立SFC后，用切割器械切开肿瘤周围的粘膜和肿瘤下方的粘膜下剥离。结果：平均切除肿瘤38.6 mm，平均肿瘤25.6 mm，1例严重纤维化的结肠肿瘤穿孔（1.5%），经内镜夹闭治疗，未行挽救手术，未输血。在一个胃和一个直肠肿瘤（3%），内窥镜止血是必要的，因为术后出血。整体内镜和组织学整块切除率分别为94%（63/67）和78%（52/67），随访1年后没有复发。结论：ESD时使用的Suvenyl和Glyceol的混合物的结果在很好的结果，这种注射液应用于ESD。
Background: Endoscopic submucosal dissection (ESD) has recently been developed for endoscopic treatment of GI tumors, which enables Lis to resect even large tumors en bloc. However, a considerable frequency of perforation has become another problem. The best way to prevent perforation is to create a sufficient submucosal fluid cushion (SFC). The aim of this study is to find out the feasibility of ESD by using a mixture of 1900 KDa hyaluronic acid (Suvenyl) and, a 10% glycerin plus 5% fructose Solution (Glyceol).Methods: Sixty-seven consecutive GI tumors in 54 patients who met indication criteria of ESD were enrolled. The mixing ratios of Suvenyl and Glyceol were 1:3 for esophageal/colorectal tumors and stomach tumors with I scar, and 1:7 for stomach tumors without scar. After creation of SFCs, mucosal incision around the tumors and submucosal dissection under the tumors were made by Cutting devices. The clinical outcomes were investigated.Results: Mean resected and tumor sizes were 38.6 and 25.6 mm, respectively Perforation occurred in one colon tumor with severe fibrosis (1.5%), which was managed by endoscopic clipping without salvage surgery No blood transfusion was performed. In one stomach and in one rectal tumor (3%), endoscopic hemostasis was necessary because of postoperative bleeding. Overall endoscopic and histologic en bloc resection rates were 94% (63/67) and 78% (52/67), respectively and there was no recurrence after follow-up of 1 year.Conclusions: ESD when using a mixture of Suvenyl and Glyceol results in excellent outcomes, and this injection solution should be used for ESD.