Usefulness of tumor traction with a snare and endoclips in gastric submucosal tumor resection:a propensity-score-matching analysis  

圈套器和止血夹肿瘤牵拉技术在胃黏膜下肿瘤内镜切除中的应用:倾向评分匹配分析

作　　者：Qiang Zhang Jian-Qun Cai Zhen Wang 

机构地区：[1]Guangdong Provincial Key Laboratory of Gastroenterology,Department of Gastroenterology,Nanfang Hospital,Southern Medical University,Guangzhou,Guangdong,P.R.China

出　　处：《Gastroenterology Report》2021年第2期125-132,I0001,I0002,共10页胃肠病学报道（英文）

摘　　要：Background:Endoscopic resection,including endoscopic submucosal dissection(ESD)and endoscopic full-thickness resection(EFR),was used to resect small gastric submucosal tumors(SMTs).Our team explored a method of tumor traction using a snare combined with endoclips to assist in the resection of SMTs.This study aims to explore the safety and effectiveness of the method.Methods:This research performed a propensity-score-matching(PSM)analysis to compare ESD/EFR assisted by a snare combined with endoclips(ESD/EFR with snare traction)with conventional ESD/EFR for the resection of gastric SMTs.Comparisons were made between the two groups,including operative time,en bloc resection rate,perioperative complications,and operation-related costs.Results:A total of 253 patients with gastric SMTs resected between January 2012 and March 2019 were included in this study.PSM yielded 51 matched pairs.No significant differences were identified between the two groups in perioperative complications or the costs of disposable endoscopic surgical accessories.However,the ESD/EFR-with-snare-traction group had a shorter median operative time(39 vs 60 min,P=0.005)and lower rate of en bloc resection(88.2%vs 100%,P¼0.027).Conclusions:ESD/EFR with snare traction demonstrated a higher efficiency and en bloc resection rate for gastric SMTs,with no increases in perioperative complications and the costs of endoscopic surgical accessories.Therefore,the method seems an appropriate choice for the resection of gastric SMTs.背景:包括内镜黏膜下剥离术(ESD)和内镜全层切除术(EFR)在内的内镜技术可用以切除较小的胃黏膜下肿瘤(SMT)。我们团队开发了一种圈套器和止血夹肿瘤牵拉方法,用以辅助SMT的内镜切除。本研究旨在评估这一技术的安全性和有效性。方法:本研究采用倾向评分匹配(PSM)分析,比较圈套器和止血夹辅助的ESD/EFR(圈套器牵拉组)与传统ESD/EFR(传统技术组)用于切除胃SMT的手术时间、整块切除率、围手术期并发症发生率及内镜治疗相关的费用。结果:2012年1月至2019年3月间收治的253例胃SMT患者纳入研究。PSM获得51对病例,两组围手术期并发症发生率和内镜耗材费用的差异均无统计学意义,但圈套器牵拉组中位手术时间缩短(39 vs 60 min,P=0.005),整块切除率提高(100%vs 88.2%,P=0.027)。结论:圈套器牵拉辅助的ESD/EFR用于胃SMT具有更高的手术效率和整块切除率,而且不会增加围手术期并发症发生风险和手术耗材费用。因此,该方法似乎是胃SMT内镜切除的良好选择。

关 键 词：endoscopic submucosal dissection endoscopic full-thickness resection gastric submucosal tumor SNARE ENDOCLIP 

分 类 号：R735[医药卫生—肿瘤]