Efficient hemostatic method for endoscopic submucosal dissection of colorectal tumors

作     者：Naohisa Yoshida Yuji Naito Munehiro Kugai Ken Inoue Naoki Wakabayashi Nobuaki Yagi Akio Yanagisawa Toshikazu Yoshikawa 

作者机构：Department of Molecular Gastroenterology and HepatologyKyoto Prefectural University of MedicineGraduate School of Medical Science Department of Surgical PathologyKyoto Prefectural University of MedicineGraduate School of Medical Science 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2010年第16卷第33期

页      面：4180-4186页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：Endoscopic submucosal dissection Colorectal tumor Hemostatic forceps Perforation Perioperative hemorrhage 

摘      要：AIM:To evaluate a new hemostatic method using hemostatic forceps to prevent perforation and perioperative hemorrhage during colonic endoscopic submucosal dissection(ESD).METHODS:We studied 250 cases,in which ESD for colorectal tumors was performed at the Kyoto Prefectural University of Medicine or Nara City Hospital between 2005 and *** developed a new hemostatic method using hemostatic forceps in December 2008 for the efficient treatment of submucosal thick *** was performed on 126 cases after adoption of the new method(the adopted group)and the new method was performed on 102 of these *** was performed on 124 cases before the adoption of the new method (the unadopted group).The details of the new method are as follows:firstly,a vessel was coagulated using the hemostatic forceps in the soft coagulation mode according to the standard procedure,and the coagulated vessel was removed using the forceps in theendocut mode without perioperative ***,the partial surrounding submucosa was dissected using the forceps in the endocut *** the current study,we evaluated the efficacy of this ***:Coagulated vessels were successfully removed using the hemostatic forceps in all 102 cases without severe perioperative *** perioperative hemorrhage occurred in five cases(4.9%);however,it was stopped by immediately reuse of the hemostatic *** partial surrounding submucosa was dissected using the forceps in all 102 *** the adopted group,the median operation time was 105 *** proportion of endoscopic en bloc resection was 92.8%(P0.01)compared to 80.6%in the unadopted *** postoperative hemorrhage and perforation rates were 2.3%and 2.3%.The rate of perforation was significantly lower than that in the unadopted group (9.6%,P0.01).We evaluated the ease of use of this method by allowing our three trainees to performed ESD on 46 cases,which were accomplished without any severe ***:The new