Usefulness of the Bridge Formation Method for Colorectal Endoscopic Submucosal Dissection: A Propensity Score-Matched Study

IF 1.5 Q3 GASTROENTEROLOGY & HEPATOLOGY JGH Open Pub Date : 2025-04-08 DOI:10.1002/jgh3.70149

Masahiro Abe, Takemasa Hayashi, Yuta Kouyama, Yutaro Ide, Tomoya Shibuya, Yuriko Morita, Kenichi Mochizuki, Yosuke Minegishi, Eri Tamura, Taishi Okumura, Tatsuya Sakurai, Yushi Ogawa, Yasuharu Maeda, Katsuro Ichimasa, Naoya Toyoshima, Masashi Misawa, Kunihiko Wakamura, Naruhiko Sawada, Toshiyuki Baba, Tetsuo Nemoto, Shin-ei Kudo

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Abstract

Aims

Colorectal endoscopic submucosal dissection (ESD) has become a standard treatment for superficial colorectal neoplasms worldwide. However, challenges remain in achieving dissection at the precise layer. In this study, we evaluated the effectiveness of a novel ESD technique involving natural traction, referred to as the bridge formation method (BFM).

Methods and Results

The two main features of the BFM are creating a large mucosal flap and leaving normal mucosa on both sides of the lesion until the bridge is made at the end of the procedure. This retrospective study included consecutive patients with 2647 colorectal lesions resected by ESD from September 2003 to December 2023. We divided them into the BFM group and the non-BFM group and conducted propensity score matching.

After propensity score matching, 1648 cases were enrolled (824 cases in each group). The en bloc resection rate was significantly higher in the BFM than non-BFM group (99.6% vs. 96.7%, p < 0.01). The R0 resection rate and the average dissection speed (㎟/min) were significantly higher in the BFM than non-BFM group (98.8% vs. 96.4%, p < 0.01, and 18.9 vs. 18.0, p = 0.03). The occurrence rates of perforation and delayed bleeding showed no significant difference between the non-BFM and BFM groups (2.8% vs. 3.6%, p = 0.40, and 1.1% vs. 1.0%, p = 1.00).

Conclusions

The BFM is a suitable method for colorectal ESD as it enables rapid dissection and improves both en bloc resection and R0 resection rates.

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结直肠内镜下粘膜下解剖桥形成法的有效性：一项倾向评分匹配研究

目的大肠内镜黏膜下剥离术（ESD）已成为全球治疗大肠表层肿瘤的标准方法。然而，在实现精确层解剖方面仍存在挑战。在这项研究中，我们评估了一种涉及自然牵引的新型 ESD 技术的有效性，这种技术被称为 "桥形成法"（BFM）。方法和结果 BFM 的两个主要特点是创建一个大的粘膜瓣，并在手术结束前在病变两侧保留正常的粘膜，直到桥形成。这项回顾性研究纳入了 2003 年 9 月至 2023 年 12 月期间通过ESD切除的 2647 例结肠直肠病变的连续患者。我们将他们分为BFM组和非BFM组，并进行了倾向得分匹配。经过倾向评分匹配后，1648 例病例入选（每组 824 例）。BFM组的全切率明显高于非BFM组（99.6% vs. 96.7%, p <0.01）。BFM组的R0切除率和平均解剖速度（㎟/min）明显高于非BFM组（98.8% vs. 96.4%，p = 0.01；18.9 vs. 18.0，p = 0.03）。穿孔率和延迟出血率在非 BFM 组和 BFM 组之间无显著差异（2.8% 对 3.6%，P = 0.40；1.1% 对 1.0%，P = 1.00）。结论 BFM 是一种适用于结肠直肠ESD的方法，因为它能实现快速解剖，提高全切率和R0切除率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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