{"title":"无镇静内镜下结肠病变粘膜下剥离的安全性：一项单中心回顾性研究。","authors":"Tzong-Yun Tsai, Shu-Huan Huang, Kun-Yu Tsai, Yueh-Chen Lin, Wen-Sy Tsai, Hsin-Yuan Hung, Jeng-Fu You","doi":"10.1007/s10151-025-03224-1","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Endoscopic submucosal dissection (ESD) has emerged as an effective technique for the en bloc and curative removal of sizable colorectal tumors. Despite ESD's advantages over traditional surgery, its primary associated complications of perforation and hemorrhage pose significant challenges. Sedation-free ESD allows for real-time reporting of symptoms by patients, improving the identification and management of complications. This study aimed to evaluate the safety of sedation-free ESD.</p><p><strong>Methods: </strong>A retrospective cohort study included patients undergoing sedation-free ESD for colorectal lesions at a tertiary center in Taiwan from 2018 to 2023. Patient demographics, lesion characteristics, procedure time, and clinical outcomes were collected. The primary outcome was safety as assessed via intraoperative complications (e.g., perforation or hemorrhage) and overall complication rates. Additional analyses included factors associated with perforation and management strategies (i.e., endoclips or surgical intervention) using univariate and multivariable logistic regression analyses.</p><p><strong>Results: </strong>A total of 134 patients were included in the study. The mean patient age was 65.3 years, with an average lesion size of 3.6 ± 1.5 cm. ESD-associated perforation or hemorrhage occurred in 6.7% and 10.4% of cases, respectively, most of which were successfully managed with endoclips. Patients with hemorrhage-compared with those without-had significantly larger lesions (median: 4.7 cm versus 3 cm, p = 0.004). Multivariable analysis revealed no statistically significant associations between lesion characteristics and perforation. No delayed perforations were reported.</p><p><strong>Conclusions: </strong>Sedation-free ESD is a safe alternative to traditional sedated ESD for colorectal lesions. Real-time symptom reporting by patients enhances management of complications. In addition, precision application of endoclips ensures optimal perforation and hemorrhage control, improving patient outcomes and safety.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"175"},"PeriodicalIF":2.9000,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Safety of sedation-free endoscopic submucosal dissection of colon lesions: a single-center retrospective study.\",\"authors\":\"Tzong-Yun Tsai, Shu-Huan Huang, Kun-Yu Tsai, Yueh-Chen Lin, Wen-Sy Tsai, Hsin-Yuan Hung, Jeng-Fu You\",\"doi\":\"10.1007/s10151-025-03224-1\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Endoscopic submucosal dissection (ESD) has emerged as an effective technique for the en bloc and curative removal of sizable colorectal tumors. Despite ESD's advantages over traditional surgery, its primary associated complications of perforation and hemorrhage pose significant challenges. Sedation-free ESD allows for real-time reporting of symptoms by patients, improving the identification and management of complications. This study aimed to evaluate the safety of sedation-free ESD.</p><p><strong>Methods: </strong>A retrospective cohort study included patients undergoing sedation-free ESD for colorectal lesions at a tertiary center in Taiwan from 2018 to 2023. Patient demographics, lesion characteristics, procedure time, and clinical outcomes were collected. The primary outcome was safety as assessed via intraoperative complications (e.g., perforation or hemorrhage) and overall complication rates. Additional analyses included factors associated with perforation and management strategies (i.e., endoclips or surgical intervention) using univariate and multivariable logistic regression analyses.</p><p><strong>Results: </strong>A total of 134 patients were included in the study. The mean patient age was 65.3 years, with an average lesion size of 3.6 ± 1.5 cm. ESD-associated perforation or hemorrhage occurred in 6.7% and 10.4% of cases, respectively, most of which were successfully managed with endoclips. Patients with hemorrhage-compared with those without-had significantly larger lesions (median: 4.7 cm versus 3 cm, p = 0.004). Multivariable analysis revealed no statistically significant associations between lesion characteristics and perforation. No delayed perforations were reported.</p><p><strong>Conclusions: </strong>Sedation-free ESD is a safe alternative to traditional sedated ESD for colorectal lesions. Real-time symptom reporting by patients enhances management of complications. In addition, precision application of endoclips ensures optimal perforation and hemorrhage control, improving patient outcomes and safety.</p>\",\"PeriodicalId\":51192,\"journal\":{\"name\":\"Techniques in Coloproctology\",\"volume\":\"29 1\",\"pages\":\"175\"},\"PeriodicalIF\":2.9000,\"publicationDate\":\"2025-10-08\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Techniques in Coloproctology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s10151-025-03224-1\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Techniques in Coloproctology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s10151-025-03224-1","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景：内镜下粘膜剥离术（ESD）已成为结肠直肠大肿瘤整体切除和根治性切除的有效技术。尽管ESD优于传统手术，但其主要相关并发症穿孔和出血带来了重大挑战。无镇静ESD允许患者实时报告症状，改善并发症的识别和管理。本研究旨在评价无镇静ESD的安全性。方法：一项回顾性队列研究纳入了2018年至2023年在台湾某三级中心接受无镇静ESD治疗的结直肠病变患者。收集患者人口统计资料、病变特征、手术时间和临床结果。主要结局是通过术中并发症（如穿孔或出血）和总并发症发生率来评估安全性。其他分析包括使用单变量和多变量逻辑回归分析与穿孔和管理策略（即内夹或手术干预）相关的因素。结果：共纳入134例患者。患者平均年龄65.3岁，平均病变大小3.6±1.5 cm。与esd相关的穿孔或出血发生率分别为6.7%和10.4%，其中大多数通过内包膜成功处理。与无出血的患者相比，出血患者的病变明显更大（中位数：4.7 cm对3 cm， p = 0.004）。多变量分析显示病变特征与穿孔之间无统计学意义的关联。无迟发性穿孔报告。结论：无镇静ESD是传统镇静ESD治疗结直肠病变的安全选择。患者的实时症状报告提高了并发症的管理。此外，内夹的精确应用确保了最佳的穿孔和出血控制，提高了患者的预后和安全性。
Safety of sedation-free endoscopic submucosal dissection of colon lesions: a single-center retrospective study.
Background: Endoscopic submucosal dissection (ESD) has emerged as an effective technique for the en bloc and curative removal of sizable colorectal tumors. Despite ESD's advantages over traditional surgery, its primary associated complications of perforation and hemorrhage pose significant challenges. Sedation-free ESD allows for real-time reporting of symptoms by patients, improving the identification and management of complications. This study aimed to evaluate the safety of sedation-free ESD.
Methods: A retrospective cohort study included patients undergoing sedation-free ESD for colorectal lesions at a tertiary center in Taiwan from 2018 to 2023. Patient demographics, lesion characteristics, procedure time, and clinical outcomes were collected. The primary outcome was safety as assessed via intraoperative complications (e.g., perforation or hemorrhage) and overall complication rates. Additional analyses included factors associated with perforation and management strategies (i.e., endoclips or surgical intervention) using univariate and multivariable logistic regression analyses.
Results: A total of 134 patients were included in the study. The mean patient age was 65.3 years, with an average lesion size of 3.6 ± 1.5 cm. ESD-associated perforation or hemorrhage occurred in 6.7% and 10.4% of cases, respectively, most of which were successfully managed with endoclips. Patients with hemorrhage-compared with those without-had significantly larger lesions (median: 4.7 cm versus 3 cm, p = 0.004). Multivariable analysis revealed no statistically significant associations between lesion characteristics and perforation. No delayed perforations were reported.
Conclusions: Sedation-free ESD is a safe alternative to traditional sedated ESD for colorectal lesions. Real-time symptom reporting by patients enhances management of complications. In addition, precision application of endoclips ensures optimal perforation and hemorrhage control, improving patient outcomes and safety.
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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