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Abstract：
BACKGROUND: Low grade intraepithelial neoplasia (LGIN) and high grade intraepithelial neoplasia (HGIN) are potential precancerous lesion of gastric neoplasms. Endoscopic submucosal dissection (ESD) is the first option for the treatment of precancerous lesion and early gastric cancer (EGC). Traction is an effective method to improve efficiency, and reduce complications during ESD. In this study, we shared a useful traction method using the clip-and-snare method with a pre-looping technique (CSM-PLT) for precancerous lesion and EGC.
METHODS: We retrospectively analyzed patients received ESD combined with CSM-PLT or conventional ESD from June 2018 to December 2021 in Shenzhen People\'s hospital. The primary outcome was resection speed.
RESULTS: Forty-two patients were enrolled in ESD combined with CSM-PLT group and sixty-five patients in conventional ESD group respectively. Baseline characteristics were comparable among two groups (P>0.05). There were no significant differences in terms of R0 resection rate, en bloc resection rate (97.6% vs. 98.5%, P = 1.000 and 97.6% vs. 96.9%, P = 1.000, respectively), operation costs (933.7 (644.1-1102.4) dollars vs. 814.7 (614.6-988.3) dollars, P = 0.107), and hospital stays (8.0 ± 3.1 days vs. 7.3 ± 3.2 days, P = 0.236). In addition, no significant difference was observed with respect to complications (P>0.05). However, the resection speed of ESD combined with CSM-PLT was faster than that of conventional ESD (11.3 (9.4-14.9) mm2/min vs. 8.0 (5.8-10.9) mm2/min, P < 0.001), particularly lesions located in anterior wall and lesser curvature. In addition, the association between ESD combined with CSM-PLT and resection speed was still supported after propensity matching scores (PMS).
CONCLUSIONS: CSM-PLT can help to improve ESD efficiency without reducing the en bloc resection rate or increasing the incidence of complications.
METHODS: We retrospectively analyzed patients received ESD combined with CSM-PLT or conventional ESD from June 2018 to December 2021 in Shenzhen People\'s hospital. The primary outcome was resection speed.
RESULTS: Forty-two patients were enrolled in ESD combined with CSM-PLT group and sixty-five patients in conventional ESD group respectively. Baseline characteristics were comparable among two groups (P>0.05). There were no significant differences in terms of R0 resection rate, en bloc resection rate (97.6% vs. 98.5%, P = 1.000 and 97.6% vs. 96.9%, P = 1.000, respectively), operation costs (933.7 (644.1-1102.4) dollars vs. 814.7 (614.6-988.3) dollars, P = 0.107), and hospital stays (8.0 ± 3.1 days vs. 7.3 ± 3.2 days, P = 0.236). In addition, no significant difference was observed with respect to complications (P>0.05). However, the resection speed of ESD combined with CSM-PLT was faster than that of conventional ESD (11.3 (9.4-14.9) mm2/min vs. 8.0 (5.8-10.9) mm2/min, P < 0.001), particularly lesions located in anterior wall and lesser curvature. In addition, the association between ESD combined with CSM-PLT and resection speed was still supported after propensity matching scores (PMS).
CONCLUSIONS: CSM-PLT can help to improve ESD efficiency without reducing the en bloc resection rate or increasing the incidence of complications.
摘要：
背景：低级别上皮内瘤变（LGIN）和高级别上皮内瘤变（HGIN）是胃癌的潜在癌前病变。内镜黏膜下剥离术（ESD）是治疗癌前病变和早期胃癌（EGC）的首选方法。牵引是提高效率的有效方法,并减少ESD期间的并发症。在这项研究中,对于癌前病变和EGC,我们分享了一种有用的牵引方法,该方法使用了夹圈套法和预循环技术(CSM-PLT).
方法：回顾性分析深圳市人民医院2018年6月至2021年12月接受ESD联合CSM-PLT或常规ESD的患者。主要结果是切除速度。
结果：ESD联合CSM-PLT组42例，常规ESD组65例。两组基线特征具有可比性(P>0.05)。R0切除率无显著差异，整体切除率(97.6%vs.98.5%,P=1.000和97.6%vs.96.9%,分别为P=1.000)，运营成本（933.7（644.1-1102.4）美元与814.7（614.6-988.3）美元，P=0.107),和住院时间(8.0±3.1天vs.7.3±3.2天,P=0.236）。此外,在并发症方面没有观察到显着差异（P>0.05）。然而,ESD联合CSM-PLT的切除速度比常规ESD快(11.3(9.4-14.9)mm2/minvs.8.0(5.8-10.9)mm2/min,P<0.001)，特别是位于前壁和较小曲率的病变。此外,在倾向匹配评分(PMS)后,ESD联合CSM-PLT与切除速度之间的相关性仍得到支持.
结论：CSM-PLT有助于提高ESD效率，而不降低整块切除率或增加并发症的发生率。
方法：回顾性分析深圳市人民医院2018年6月至2021年12月接受ESD联合CSM-PLT或常规ESD的患者。主要结果是切除速度。
结果：ESD联合CSM-PLT组42例，常规ESD组65例。两组基线特征具有可比性(P>0.05)。R0切除率无显著差异，整体切除率(97.6%vs.98.5%,P=1.000和97.6%vs.96.9%,分别为P=1.000)，运营成本（933.7（644.1-1102.4）美元与814.7（614.6-988.3）美元，P=0.107),和住院时间(8.0±3.1天vs.7.3±3.2天,P=0.236）。此外,在并发症方面没有观察到显着差异（P>0.05）。然而,ESD联合CSM-PLT的切除速度比常规ESD快(11.3(9.4-14.9)mm2/minvs.8.0(5.8-10.9)mm2/min,P<0.001)，特别是位于前壁和较小曲率的病变。此外,在倾向匹配评分(PMS)后,ESD联合CSM-PLT与切除速度之间的相关性仍得到支持.
结论：CSM-PLT有助于提高ESD效率，而不降低整块切除率或增加并发症的发生率。
