单腔内镜双弯式用于胃困难部位内镜黏膜下剥离术的安全性及有效性初探（含视频）

Safety and effectiveness of single‑channel endoscope multibending‑assisted endoscopic submucosal dissection for gastric lesions in difficult locations (with video)

摘要:

胃底穹窿部和胃体上部等属于内镜黏膜下剥离术（endoscopic submucosal dissection，ESD）操作困难的部位，这些部位的病变ESD及其衍生技术的切除效果不满意，主要原因在于内镜前端难以抵近操作。笔者在软式肠镜进镜过弯形成α袢和双腔双弯曲内镜的启发下，通过单腔治疗型内镜形成双弯形态——单腔内镜双弯式，并于2021年6—12月间对南京中医药大学附属医院消化内镜中心收治的3例胃底穹窿部、2例胃体上部大弯侧和1例胃底贲门下后壁病变患者进行了单腔内镜双弯式辅助下切除治疗。术中尝试2~3次后，6例均成功建立单腔内镜双弯式，用时60~120 s。6例均顺利完成内镜下切除治疗，包括4例ESD和2例内镜全层切除术，总体手术耗时20~80 min，均无明显并发症发生。初步结果显示，对于胃ESD操作困难部位的病变，ESD及其衍生技术治疗过程中采用单腔内镜双弯式辅助安全、有效，术中内镜前端易于靠近病变，剥离视野暴露良好，剥离平面稳定。

Abstract:

The gastric fundus fornix and upper part of the gastric body pose challenges for endoscopic submucosal dissection (ESD), resulting in unsatisfactory resection outcomes for lesions in these areas,because of the difficulty in the endoscope reaching the lesion site. Drawing inspiration from the formation of α loop during flexible colonoscopy and double‑channel multibending gastroscope, a single‑channel treatment gastroscope was utilized to create a multibending state (referred to as single‑channel endoscope multibending method, SCMB). This method was employed to treat 6 patients with lesions in the stomach at Digestive Endoscopy Center of Affiliated Hospital of Nanjing University of Chinese Medicine from June 2021 to December 2021. There were 3 cases in the gastric fundus fornix, 2 cases in the greater curvature on the upper part of the gastric body, and 1 case in the posterior wall of gastric fundus and subcardia. After 2‑3 attempts during surgery, SCMB was successfully performed in all cases within 60‑120 seconds. All 6 cases completed successful endoscopic resection within 20‑80 minutes without significant complications, including 4 cases of ESD and 2 cases of endoscopic full‑thickness resection (EFR). Preliminary results indicate that SCMB method during ESD and its derivative technologies are both safe and effective for lesions in challenging areas where gastric ESD is difficult to perform. During surgery, this approach facilitates the front end of endoscope access to the lesion, providing a clear visual field and a stable dissection plane.