Long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms
Long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms
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DOI：
10.1016/j.gie.2009.04.044
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发表时间：
2009-11-01
影响因子：
7.7
通讯作者：
Omata, Masao
中科院分区：
文献类型：
--
作者：
Ono, Satoshi;Fujishiro, Mitsuhiro;Omata, Masao
背景资料：内镜粘膜下剥离术（ESD）治疗浅表食管鳞状细胞肿瘤（ESCNs）的长期结果迄今尚未得到评价。目的：评估我们连续病例中ESD治疗ESCNs的长期结果。设计和设置：单一机构的回顾性研究。患者和干预：从2002年1月至2008年7月，84例患者的107个浅表ESCN接受ESD治疗。根据每个患者浸润最深的病变将入选患者分为2组：A组，上皮内肿瘤或浸润性癌局限于粘膜固有层，B组，浸润性癌深于粘膜固有层。主要结果测量：整体切除率，完全切除率和并发症作为短期结果进行评价。结果：全切率100%，全切率88%，穿孔伴纵隔气肿4例（4%）。无患者发生大出血。在632天（范围8-2358）的中位观察期间，15例（18%）患者发生了良性食管狭窄伴吞咽困难，通过球囊扩张成功治疗，中位治疗时间为2次（范围1-20）。1例ESD术后6个月局部复发。在2例粘膜肌层浸润性癌患者中，ESD后9个月和18个月观察到远处转移。在观察期内，3例患者死于食管癌。A组和B组的5年病因特异性生存率分别为100%和85%，respectivelyLimitations：这是一项回顾性研究，随访时间相对较短，来自一个单一institution.Conclusion的少数患者：这项长期随访研究表明，ESD是一种潜在的治疗浅表ESCN。存在穿孔和狭窄的实质性风险，经内镜成功处理。（Gastrointest Endosc 2009;70：860-6。）
Background: The long-term outcomes of endoscopic submucosal dissection (ESD) for superficial esophageal squamous cell neoplasms (ESCNs) have not been evaluated to date.Objective: Assess the long-term outcomes of ESD for ESCNs from our consecutive cases.Design and Setting: Retrospective study from a single institution.Patients and Intervention: From January 2002 to July 2008, 107 superficial ESCNs in 84 patients were treated by ESD. The enrolled patients were divided into 2 groups based on the lesion with the deepest invasion in each patient: group A, intraepithelial neoplasm or invasive carcinoma limited to the lamina propria mucosa and group B, invasive carcinoma deeper than the lamina propria mucosa.Main Outcome Measurements: Rates of en bloc resection, complete resection, and complication were evaluated as short-term outcomes. Overall survival, cause-specific survival, and postoperative stricture rates were evaluated as long-term outcomes.Results: The rates of en bloc resection and complete resection were 100% and 88%, respectively Perforation accompanied by mediastinal emphysema was observed in 4 (4%) patients. No patient experienced massive bleeding. During the median observation of 632 days (range 8-2358), 15 (18%) patients experienced benign esophageal stricture with dysphagia, which was successfully managed by balloon dilation for a median of 2 sessions (range 1-20). One patient had local recurrence 6 months after ESD. In 2 patients with intramucosal invasive carcinomas in the muscularis mucosa, distant metastases were observed 9 and 18 months after ESD. During the observation period, 3 patients died of esophageal carcinoma. The 5-year cause-specific survival rates of groups A and B were 100% and 85%, respectivelyLimitations: This was a retrospective study with a relatively short follow-up and a small number of patients from a single institution.Conclusion: This long-term follow-up study revealed that ESD is a potentially curative treatment for superficial ESCNs. There were substantial risks of perforation and stricture that were successfully managed endoscopically. (Gastrointest Endosc 2009;70:860-6.)