结直肠内镜粘膜下剥离术（ESD）尽管有用，但仍具有挑战性。与传统 ESD (CESD) 相比，水下 ESD (UESD) 提供更好的牵引力和更清晰的粘膜下层视图。本研究比较了 UESD 和 CESD 对于大型（20-50 毫米）横向扩散肿瘤 (LST) 的效率。预先计划的样本量是根据我们之前的经验计算的。结果，分别需要 28 名患者进入 UESD 组或 CESD 组。主要结果是总手术时间，次要结果是解剖速度。共纳入 56 名患者，每组总共 28 名患者。 UESD 和 CESD 组的 LST 平均尺寸分​​别为 31.6 mm 和 31.3 mm。 UESD 和 CESD 组中 67.9% 和 60.7% 的患者观察到纤维化。 UESD 组的总手术时间（平均值 [SD]）分别显着短于 CESD 组（49.5 分钟 [20.3] vs 75.7 分钟 [36.1]；平均差，-26.2 分钟；95% CI，-42.0至-10.5）。 UESD 组的解剖速度明显快于 CESD 组（21.9 mm2/min [6.9] vs 15.2 mm2/min [7.3]；平均差，6.7 mm2/min；95% CI，2.8-10.4）。各组之间的 R0 切除率或整块切除率没有差异。两组均未观察到穿孔。UESD 在总手术时间和解剖速度方面优于 CESD。 UESD 可被推荐作为切除大 LST 的首选方法。版权所有 © 2024 美国胃肠内镜协会。由爱思唯尔公司出版。保留所有权利。

Colorectal endoscopic submucosal dissection (ESD) is challenging despite its usefulness. Underwater ESD (UESD) provides better traction and a clearer view of the submucosal layer than conventional ESD (CESD). This study compared the efficiency of UESD and CESD for large (20-50 mm) laterally spreading tumor (LST).Preplanned sample size was calculated from our previous experience. As a results, 28 patients were required to UESD group or CESD group, respectively. The primary outcome was total procedure time while the secondary outcome was dissection speed.Fifty-six patients were enrolled and a total of 28 patients were assigned to each group. The mean size of LST was 31.6 mm and 31.3 mm in the UESD and CESD group, respectively. Fibrosis was observed in 67.9% and 60.7% patients in the UESD and CESD group. Total procedure time (mean [SD]) for the UESD group was significantly shorter than that for the CESD group, respectively (49.5 minutes [20.3] vs 75.7 minutes [36.1]; mean difference, -26.2 minutes; 95% CI, -42.0 to -10.5). Dissection speed of the UESD group was significantly faster than that of the CESD group (21.9 mm2/min [6.9] vs 15.2 mm2/min [7.3]; mean difference, 6.7 mm2/minutes; 95% CI, 2.8-10.4). There was no difference between groups in the R0 resection rate or en bloc resection rate. No perforations were observed in either group.UESD was superior to CESD in total procedure time and dissection speed. UESD can be recommended as the preferred method for the resection of large LST.Copyright © 2024 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.