ENDOCUT Q凝固比例与内镜下黏膜下剥离术后食管狭窄相关
ENDOCUT Q coagulation fraction is associated with esophageal stricture after endoscopic submucosal dissection.
作者
作者单位
- Department of Endoscopy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Banshan Road 1, Gongshu District, Hangzhou, 310022, Zhejiang, China.
- Department of Endoscopy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Banshan Road 1, Gongshu District, Hangzhou, 310022, Zhejiang, China. wangshi@zjcc.org.cn.
摘要
中文
内镜下黏膜下剥离术（ESD）具有相当大的食管狭窄形成风险。我们旨在使用自主研发的能量传感器量化ENDOCUT Q模式中嵌入的凝固成分，并探讨其与ESD术后食管狭窄的关系。回顾性纳入2021年至2024年间因早期食管癌接受ESD的患者。使用特制的能量传感器实时测量电外科输出，可分别量化ENDOCUT Q模式中的切割和凝固能量。ENDOCUT Q凝固比例（ECF）定义为凝固能量占ENDOCUT Q总能量的比例。在探索性分类分析中，根据队列衍生阈值将ECF分为低（<1%）、中（1-10%）和高（>10%）。采用多变量逻辑回归确定与ESD术后食管狭窄相关的独立因素。在681例患者中，124例（18.2%）发生术后食管狭窄。多变量分析中，环周范围>3/4（比值比[OR] 10.91，95%置信区间[CI] 4.94-24.11，p<0.001）、FORCED COAG能量密度≥22.02 J/cm²（OR 3.55，95%CI 2.03-6.19，p<0.001）和高ECF（OR 3.03，95%CI 1.18-7.81，p=0.022）与术后狭窄独立相关。在环周范围>3/4且发生狭窄的患者的探索性分析中，高ECF也与难治性食管狭窄相关。ECF与ESD术后食管狭窄独立相关。这些发现提示，与凝固相关的热暴露可能与狭窄形成有关，ECF可能作为电外科暴露的潜在可量化操作水平标志物。
English
Endoscopic submucosal dissection (ESD) carries a substantial risk of esophageal stricture formation. We aimed to quantify the coagulation component embedded within ENDOCUT Q mode using a custom-developed energy sensor and to investigate its association with post-ESD esophageal stricture. Patients who underwent ESD for early esophageal cancer between 2021 and 2024 were retrospectively reviewed. A custom energy sensor was used to measure real-time electrosurgical output, allowing separate quantification of cutting and coagulation energy in ENDOCUT Q mode. The ENDOCUT Q coagulation fraction (ECF) was defined as the proportion of coagulation energy within total ENDOCUT Q energy. For exploratory categorical analyses, ECF was classified as low (< 1%), medium (1-10%), or high (> 10%) using cohort-derived thresholds. Independent factors associated with post-ESD esophageal stricture were identified using multivariable logistic regression. Among 681 patients, post-ESD stricture occurred in 124 patients (18.2%). In multivariable analysis, circumferential extent > 3/4 (odds ratio [OR] 10.91, 95% confidence interval [CI] 4.94-24.11, p < 0.001), FORCED COAG energy density ≥ 22.02 J/cm2 (OR 3.55, 95% CI 2.03-6.19, p < 0.001), and high ECF (OR 3.03, 95% CI 1.18-7.81, p = 0.022) were independently associated with post-ESD stricture. In an exploratory analysis among patients with circumferential extent > 3/4 who developed stricture, high ECF was also associated with refractory esophageal stricture. ECF was independently associated with post-ESD esophageal stricture. These findings suggest that coagulation-related thermal exposure may be associated with stricture formation and that ECF may serve as a potential quantifiable procedure-level marker of electrosurgical exposure.
分类与指标
- 研究类型
- 临床研究
- 病种
- 食管癌
- JCR 分区
- Q1
- 影响因子
- 11.8
- 新锐分区
- 1区