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Abstract：
Endoscopic submucosal dissection (ESD) of fibrotic colorectal lesions is difficult and has a high complication rate. There are only a few reports on the utility of orthodontic rubber band (ORB) traction in reducing the difficulty of this procedure. This study aimed to investigate the risk factors for perforation when applying ORB traction during ESD of fibrotic colorectal lesions. We continuously collected the clinical data of 119 patients with fibrotic colorectal lesions who underwent ESD with ORB and clip traction between January 2019 and January 2024. Possible risk factors for perforation were analyzed. The median ORB-ESD operative time was 40 (IQR 28-62) min, and the en bloc and R0 resection rates were 94.1% and 84.0%, respectively. Perforation occurred in 16 of 119 patients (13.4%). The lesion size, lesion at the right half of the colon or across an intestinal plica, the degree of fibrosis, operation time, and the surgeon\'s experience were associated with perforation during ORB-ESD (P < 0.05). Multivariate logistic regression analysis showed that lesions in the right colon (OR 9.027; 95% CI 1.807-45.098; P = 0.007) and those across an intestinal plica (OR 7.771; 95% CI 1.298-46.536; P = 0.025) were independent risk factors for perforation during ORB-ESD. ORB-ESD is an effective and feasible approach to treat fibrotic colorectal lesions. Adequate preoperative evaluation is required for lesions in the right colon and across intestinal plicas to mitigate the risk of perforation.
摘要：
内镜黏膜下剥离术(ESD)治疗结直肠纤维化病变难度大,并发症发生率高。关于正畸橡皮筋（ORB）牵引在降低此过程难度方面的实用性，只有很少的报道。本研究旨在探讨在纤维化结直肠病变ESD中应用ORB牵引时发生穿孔的危险因素。我们连续收集了119例纤维化结直肠病变患者的临床资料，这些患者在2019年1月至2024年1月期间接受了ORB和夹子牵引的ESD治疗。分析穿孔可能的危险因素。中位ORB-ESD手术时间为40(IQR28-62)min，整体切除率和R0切除率分别为94.1%和84.0%，分别。119例患者中有16例发生穿孔（13.4%）。病变的大小,结肠右半或肠道皱褶上的病变，纤维化的程度，操作时间,手术经验与ORB-ESD穿孔相关(P<0.05)。多因素logistic回归分析显示，右半结肠病变（OR9.027；95%CI1.807~45.098；P=0.007）和肠道皱折病变（OR7.771；95%CI1.298~46.536；P=0.025）是ORB-ESD穿孔的独立危险因素。ORB-ESD是治疗纤维化结直肠病变的有效可行方法。需要对右侧结肠和整个肠丛的病变进行充分的术前评估，以减轻穿孔的风险。
