X Leng, W Wang, F Wang, H Cang, Y Gao, H Liu, Y Sun
{"title":"夹血-缝合-橡皮筋牵引提高结肠ESD的疗效：一项随机对照试验。","authors":"X Leng, W Wang, F Wang, H Cang, Y Gao, H Liu, Y Sun","doi":"10.1007/s10151-025-03194-4","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to evaluate the efficacy and safety of a novel, simple internal traction method using a hemoclip, suture, and rubber band during endoscopic submucosal dissection (ESD) for colonic lesions.</p><p><strong>Methods: </strong>A total of 96 patients undergoing ESD at Jiangyin Hospital Affiliated with Nantong University between January 2021 and December 2024 were randomized into two groups: Group A (n = 48) underwent conventional ESD, while Group B (n = 48) underwent ESD with hemoclip-suture-rubber band traction. The study included patients with early stage colon cancer, precancerous lesions (e.g., adenomas with high-grade dysplasia), and neuroendocrine tumors. Outcome measures included total procedure time, mucosal dissection time, number of submucosal injections, en bloc resection rate, adverse events, and the size of lesion area.</p><p><strong>Results: </strong>The hemoclip-suture-rubber band traction group (Group B) demonstrated significantly shorter total procedure time (72.63 ± 34.14 min versus 85.13 ± 38.18 min, P < 0.05) and mucosal dissection time (53.56 ± 29.03 min versus 71.63 ± 39.18 min, P < 0.001) compared with the conventional ESD group (Group A). Group B also required significantly fewer submucosal injections (1.63 ± 1.23 versus 4.75 ± 1.62, P < 0.001). Lesions in Group B were significantly larger (7.650 [2.857, 10.386] cm<sup>2</sup> versus 4.895 [2.062, 6.774] cm<sup>2</sup>, P < 0.05). There were no statistically significant differences in en bloc resection rate or adverse events between the two groups (P > 0.05). However, in Group B, two patients experienced intraoperative muscularis propria injury (2/48, 4.2%) and presented with postoperative abdominal pain.</p><p><strong>Conclusions: </strong>The hemoclip-suture-rubber band traction technique facilitates colonic ESD by reducing procedure time and the need for submucosal injections, especially in larger lesions.While overall safety is comparable to conventional ESD, the potential for muscularis propria injury warrants further study in larger, multicenter trials.This simple and effective method holds promise for improving the efficiency and potentially the safety of colonic ESD.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"156"},"PeriodicalIF":2.9000,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12310896/pdf/","citationCount":"0","resultStr":"{\"title\":\"Hemoclip-suture-rubber band traction improves efficiency of colonic ESD: a randomized controlled trial.\",\"authors\":\"X Leng, W Wang, F Wang, H Cang, Y Gao, H Liu, Y Sun\",\"doi\":\"10.1007/s10151-025-03194-4\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>The objective of this study was to evaluate the efficacy and safety of a novel, simple internal traction method using a hemoclip, suture, and rubber band during endoscopic submucosal dissection (ESD) for colonic lesions.</p><p><strong>Methods: </strong>A total of 96 patients undergoing ESD at Jiangyin Hospital Affiliated with Nantong University between January 2021 and December 2024 were randomized into two groups: Group A (n = 48) underwent conventional ESD, while Group B (n = 48) underwent ESD with hemoclip-suture-rubber band traction. The study included patients with early stage colon cancer, precancerous lesions (e.g., adenomas with high-grade dysplasia), and neuroendocrine tumors. Outcome measures included total procedure time, mucosal dissection time, number of submucosal injections, en bloc resection rate, adverse events, and the size of lesion area.</p><p><strong>Results: </strong>The hemoclip-suture-rubber band traction group (Group B) demonstrated significantly shorter total procedure time (72.63 ± 34.14 min versus 85.13 ± 38.18 min, P < 0.05) and mucosal dissection time (53.56 ± 29.03 min versus 71.63 ± 39.18 min, P < 0.001) compared with the conventional ESD group (Group A). Group B also required significantly fewer submucosal injections (1.63 ± 1.23 versus 4.75 ± 1.62, P < 0.001). Lesions in Group B were significantly larger (7.650 [2.857, 10.386] cm<sup>2</sup> versus 4.895 [2.062, 6.774] cm<sup>2</sup>, P < 0.05). There were no statistically significant differences in en bloc resection rate or adverse events between the two groups (P > 0.05). 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引用次数: 0
摘要
目的：本研究的目的是评估一种新的、简单的内牵引方法，即在内镜下粘膜下剥离（ESD）中使用血夹、缝合线和橡皮筋进行结肠病变的疗效和安全性。方法：选取2021年1月~ 2024年12月在南通大学附属江阴医院行ESD的患者96例，随机分为两组：A组（48例）行常规ESD， B组（48例）行血夹-缝合-橡皮筋牵引ESD。该研究包括早期结肠癌、癌前病变（如腺瘤伴高度发育不良）和神经内分泌肿瘤患者。结果测量包括总手术时间、粘膜剥离时间、粘膜下注射次数、整体切除率、不良事件和病变面积大小。结果：血夹-缝线-橡皮筋牵引组（B组）总手术时间明显缩短（72.63±34.14 min vs 85.13±38.18 min, P < 0.05）；B组有2例患者术中固有肌层损伤（2/48,4.2%），术后出现腹痛。结论：血夹-缝合线-橡皮筋牵引技术可减少手术时间和粘膜下注射的需要，特别是在较大的病变中，有利于结肠ESD。虽然总体安全性与传统ESD相当，但其固有肌层损伤的可能性值得在更大规模的多中心试验中进一步研究。这种简单有效的方法有望提高结肠ESD的效率和潜在的安全性。
Hemoclip-suture-rubber band traction improves efficiency of colonic ESD: a randomized controlled trial.
Objective: The objective of this study was to evaluate the efficacy and safety of a novel, simple internal traction method using a hemoclip, suture, and rubber band during endoscopic submucosal dissection (ESD) for colonic lesions.
Methods: A total of 96 patients undergoing ESD at Jiangyin Hospital Affiliated with Nantong University between January 2021 and December 2024 were randomized into two groups: Group A (n = 48) underwent conventional ESD, while Group B (n = 48) underwent ESD with hemoclip-suture-rubber band traction. The study included patients with early stage colon cancer, precancerous lesions (e.g., adenomas with high-grade dysplasia), and neuroendocrine tumors. Outcome measures included total procedure time, mucosal dissection time, number of submucosal injections, en bloc resection rate, adverse events, and the size of lesion area.
Results: The hemoclip-suture-rubber band traction group (Group B) demonstrated significantly shorter total procedure time (72.63 ± 34.14 min versus 85.13 ± 38.18 min, P < 0.05) and mucosal dissection time (53.56 ± 29.03 min versus 71.63 ± 39.18 min, P < 0.001) compared with the conventional ESD group (Group A). Group B also required significantly fewer submucosal injections (1.63 ± 1.23 versus 4.75 ± 1.62, P < 0.001). Lesions in Group B were significantly larger (7.650 [2.857, 10.386] cm2 versus 4.895 [2.062, 6.774] cm2, P < 0.05). There were no statistically significant differences in en bloc resection rate or adverse events between the two groups (P > 0.05). However, in Group B, two patients experienced intraoperative muscularis propria injury (2/48, 4.2%) and presented with postoperative abdominal pain.
Conclusions: The hemoclip-suture-rubber band traction technique facilitates colonic ESD by reducing procedure time and the need for submucosal injections, especially in larger lesions.While overall safety is comparable to conventional ESD, the potential for muscularis propria injury warrants further study in larger, multicenter trials.This simple and effective method holds promise for improving the efficiency and potentially the safety of colonic ESD.
期刊介绍：
Techniques in Coloproctology is an international journal fully devoted to diagnostic and operative procedures carried out in the management of colorectal diseases. Imaging, clinical physiology, laparoscopy, open abdominal surgery and proctoperineology are the main topics covered by the journal. Reviews, original articles, technical notes and short communications with many detailed illustrations render this publication indispensable for coloproctologists and related specialists. Both surgeons and gastroenterologists are represented on the distinguished Editorial Board, together with pathologists, radiologists and basic scientists from all over the world. The journal is strongly recommended to those who wish to be updated on recent developments in the field, and improve the standards of their work.
Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1965 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the Principles of Laboratory Animal Care (NIH publication no. 86-23 revised 1985) were followed as were applicable national laws (e.g. the current version of the German Law on the Protection of Animals). The Editor-in-Chief reserves the right to reject manuscripts that do not comply with the above-mentioned requirements. Authors will be held responsible for false statements or for failure to fulfill such requirements.
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