Modified endoscopic mucosal resection for the treatment of early gastrointestinal lesions
10.3760/cma.j.cn441530-20241022-00347
- VernacularTitle:改良内镜下黏膜切除术治疗消化道早期病变
- Author:
Wenfeng CHEN
1
;
Wenhua WU
;
Xiangping ZHANG
;
Wenwei FAN
Author Information
1. 广东医科大学附属东莞儿童医院 东莞市第八人民医院消化内科，东莞 523000
- Publication Type:Journal Article
- Keywords:
Endoscopic mucosal resection, modified;
Early Gastrointestinal Lesions;
Snare
- From:
Chinese Journal of Gastrointestinal Surgery
2024;27(12):1284-1287
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the clinical efficacy of modified endoscopic mucosal resection (EMR) in the management of early gastrointestinal lesions.Methods:Upon endoscopic identification of the lesion, normal saline is injected into the submucosa to establish a fluid cushion, which elevates the lesion's mucosa. Methylene blue may also be applied to improve visualization of the relationship between the submucosa and muscular layer. A snare with a tip diameter of 2-3 mm is utilized to circumferentially incise the mucosal layer at the lesion's edge, forming a circular groove. The snare is anchored within this groove, allowing for complete resection of the lesion in a single step. The procedure involves a slow and alternating technique of electrosurgical cutting and coagulation to minimize bleeding risks, while upward tension on the snare during cutting reduces perforation risks. Direct coagulation of exposed blood vessels is performed using the snare tip, and hemostatic clips are applied to larger defects; nylon sutures may be utilized for substantial wounds.Results:Between June 2015 and April 2024, modified EMR was performed on 65 patients with early gastrointestinal lesions at Dongguan Children's Hospital, Guangdong Medical University. The mean operative time was (15.2 ± 3.1) minutes, with a complete resection rate of 100% and negative margins confirmed. Postoperative complications included one case each of delayed bleeding and electrosurgical syndrome. The average cost of consumables was (1887.2±187.6) yuan. Follow-up colonoscopies at 3 and 6 months postoperatively indicated no recurrences.Conclusions:Modified EMR demonstrates a short operative time, high safety and efficacy, and reduced material costs in the treatment of early gastrointestinal mucosal lesions.
