위 상피하 병변의 내시경 점막하 굴출을 위한 종방향 절개 효과 평가
April 28th, 2026
이 프로토콜은 위 상피하 병변의 절제와 결손 봉합을 용이하게 하기 위해 고안된 종방향 절개 내시경 점막하 굴출술을 설명합니다.
본 연구는 내시경 점막하 굴출에서 종방향과 원형 절개를 비교하여 어느 쪽이 더 빠르고 안전한지 판단합니다. 원형 절개는 봉합하기 어려운 큰 결손을 만듭니다. 종방향 절개는 폐쇄를 단순화하고 수술 시간을 단축합니다.
이 기술은 2cm 이하의 작은 위 상피하 병변을 내시경으로 제거하는 데 이상적입니다. 우선, 일회용 전기수술용 칼을 사용해 병변 가장자리에서 3밀리미터에서 5밀리미터 바깥쪽에 원형 패턴으로 여러 점을 표시하여 절제 경계를 정의합니다. 인디고 루즈 점막하 주사를 시행할 때는 바늘을 조직 깊숙이 밀어 넣으세요.
천천히 빼면서 주사하여 끝이 점막하 중간층 내에 머무르도록 하세요. 점막 표면이 빠르고 균일하며 지속적으로 상승하여 매끄럽고 돔 모양의 점막 융기가 형성되는지 확인하세요. 다음으로, 일회용 전기수술용 칼을 사용해 병변의 중심축을 따라 점막과 점막하를 관통하여 병변의 전체 종방향 크기를 넘도록 세로 절개합니다.
전기수술용 칼을 사용해 병변 아래의 점막하 결합 조직을 조심스럽게 해부하고 분리하세요. 다음으로, 병변을 완전히 노출시키고 부착물에서 완전히 분리하면서 기저 근육층을 최대한 보존하세요. 분리 과정에서 출혈이 감지되면 전기외과 칼로 경미한 출혈 혈관을 응고시키세요.
절제 결함에 활성 출혈이나 혈관이 있는지 꼼꼼히 점검하세요. 출혈 부위나 고위험 혈관은 일회용 전기적 정혈 겸자로 치료하여 지연 출혈을 방지하세요. 결손을 봉합하기 위해 먼저 중간중간 흡인하여 결손 가장자리를 근사하고 절단을 위한 조직 간격을 줄이세요.
클립의 한쪽 턱으로 결손 부위의 근위 점막 가장자리를 물립니다. 그 다음 반대쪽 턱으로 원위 점막 가장자리를 걸고 있습니다. 클립을 닫은 채 지속적인 흡입을 유지하세요.
다음으로, 점막 가장자리를 근사하기 위해 클립을 순차적으로 부착하여 전체 결손이 완전히 반대 방향으로 나올 때까지 작업합니다. 개선된 그룹과 기존 그룹 간 대부분의 기준 인구통계학적 및 임상 변수에서 통계적으로 유의한 차이는 발견되지 않았습니다. 개선된 그룹은 기존 그룹에 비해 평균 작동 시간이 현저히 짧았다.
두 그룹 모두 천공, 복부 농양, 발열 또는 심한 복통과 같은 심각한 수술 후 합병증은 발생하지 않았습니다. 주요 합병증 발생률은 두 그룹 모두 0%였으며, 통계적으로 유의한 차이는 발견되지 않았습니다. 이 프로토콜은 두 절개 기법 간 수술 시간, 성공률, 합병증을 정확히 측정할 수 있게 해줍니다.
가장 중요한 과제는 종방향 절개가 병변의 긴 축 위에 정확히 중심에 있도록 하는 것입니다.
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Overview
This article details a protocol for longitudinal incision endoscopic submucosal excavation (ESE) as an improved method for removing small gastric subepithelial lesions (SELs ≤ 2 cm). The longitudinal incision technique is compared to the conventional circular incision, demonstrating advantages in operative efficiency, defect closure, and safety.
Key Study Components
Area of Science
- Gastroenterology
- Endoscopic surgery
- Minimally invasive procedures
Background
- Endoscopic submucosal excavation (ESE) is used to manage gastric subepithelial lesions.
- Traditional circular incisions can create large defects that are difficult to close.
- Efficient closure and reduced operative time are important for patient outcomes.
- There is a need for improved techniques to optimize ESE for small gastric SELs.
Purpose of Study
- To present a detailed protocol for longitudinal incision ESE.
- To compare the longitudinal incision technique with the conventional circular incision in terms of procedural success, operative time, and safety.
- To assess the feasibility and technical outcomes of the new approach.
Methods Used
- Marking the lesion margin with dots in a circular pattern, 3–5 mm outside the lesion edge.
- Submucosal injection of indigo rouge to elevate the mucosa.
- Making a longitudinal incision along the central axis of the lesion using an electrosurgical knife.
- Dissecting and separating submucosal tissue to fully expose and free the lesion.
- Hemostasis using electrosurgical knife and hemostatic forceps as needed.
- Primary closure of the defect with sequential application of metal clips under suction.
- Retrospective comparison of outcomes between longitudinal (n=21) and circular (n=31) incision groups.
Main Results
- The longitudinal incision group achieved a 100% procedural success rate.
- Mean operation time was significantly shorter for the longitudinal group (51.43 ± 5.56 min) compared to the circular group (70.00 ± 6.96 min, P=0.0179).
- Reduced need for advanced closure devices in the longitudinal group (5% vs. 28%).
- Low complication rates in both groups, with no serious postoperative events.
Conclusions
- The longitudinal incision ESE technique is safe, effective, and feasible for gastric SELs ≤ 2 cm.
- This method offers practical advantages in operative efficiency and defect management.
- It may reduce the need for additional closure devices and consumables.
Frequently Asked Questions
Executive Industry Relevance
Efficient and reproducible tissue resection methods are critical for translational research models and preclinical tool development in gastrointestinal disease. The longitudinal incision protocol for endoscopic submucosal excavation (ESE) offers improved operative efficiency and defect management, supporting standardized workflows for small gastric subepithelial lesion removal. This technique enables precise measurement of procedural variables, facilitating robust comparison and optimization in discovery-stage tool validation.
Strategic Applications in Biopharma R&D
Early Discovery & Target Validation
- Enables controlled hypothesis testing of tissue resection strategies in disease-relevant gastric models.
- Supports mechanistic de-risking by reducing procedural variability and improving closure outcomes.
- Facilitates functional validation of endoscopic tools and closure devices in preclinical settings.
Screening & Assay Development
- Provides a standardized protocol for generating reproducible tissue defects for device or biomarker assay development.
- Improves assay readiness by minimizing closure complexity and consumable variability.
- Enables quantitative measurement of operative time, success rates, and complication profiles for comparative studies.
Translational & Preclinical Research
- Aligns with translational models requiring precise, low-complication tissue manipulation.
- Supports continuity from discovery through preclinical validation by enabling consistent procedural endpoints.
- Reduces risk in advancing new endoscopic technologies or closure devices toward clinical evaluation.
Pipeline & Workflow Integration
This protocol fits within the continuum from early discovery tool validation to preclinical model optimization for gastrointestinal research and device development.
- Discovery Biology: Supports hypothesis-driven comparison of incision and closure strategies in gastric tissue models.
- Screening: Provides reproducible, quantitative outputs for evaluating device performance and closure efficacy.
- Analytics: Enables direct measurement of operative time, procedural success, and complication rates for robust statistical analysis.
- Translational Research: Facilitates risk-adjusted advancement of endoscopic techniques and closure devices in preclinical pipelines.
- Enterprise Reuse: Establishes a reusable protocol for standardized tissue resection and closure studies across research teams.
Operational & Enterprise Impact
- Scientific Value: Increases predictive confidence in procedural outcomes and reduces mechanistic ambiguity in tissue resection studies.
- Operational Value: Enhances standardization, reproducibility, and scalability of endoscopic protocols for research and development.
- Strategic Value: Supports better go/no-go decisions for device and technique advancement, improving capital efficiency.
- Portfolio Impact: Enables risk-adjusted prioritization of endoscopic technologies and closure solutions in translational pipelines.
Implementation Considerations
- Requires expertise in endoscopic technique and precise lesion localization.
- Needs access to electrosurgical knives, hemostatic forceps, and standardized closure devices.
- Demands cross-team protocol standardization for reproducible outcomes.
- Adaptation may be needed for lesions larger than 2 cm or in non-gastric tissues.
- Centering the incision over the lesion's long axis is a key technical challenge.
