Depth of resection using two different endoscopic mucosal resection techniques
Depth of resection using two different endoscopic mucosal resection techniques
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DOI：
10.1055/s-2007-995529
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发表时间：
2008-05-01
期刊：
影响因子：
9.3
通讯作者：
Lightdale, C. J.
中科院分区：
文献类型：
--
作者：
Abrams, J. A.;Fedi, P.;Lightdale, C. J.
背景和研究目的：内镜下粘膜切除术（EMR）已用于治疗巴雷特食管的高度不典型增生（HGD）和粘膜内癌（IMCA），使用两种不同的帽辅助技术，即“注射、抽吸和切割”和“带圈套器”。之前的工作已经证明了可比较的样本直径。然而，之前尚未对这两种技术的切除深度进行比较。 患者和方法：从 Barrett 食管患者数据库中，我们确定了使用 EMR 从 HGD 或 IMCA 患者身上取出的 40 个连续标本，其中 20 个标本来自“注射、吸吮和切割”以及“带圈套器”技术。由两名病理学家分别评估和测量标本的最大直径和深度，以及切除最深边缘处粘膜下层和固有肌层的存在情况。收集有关临床结果和狭窄形成的后续数据。结果：两种技术的标本平均深度没有显着差异（0.51 厘米与 0.50 厘米，P = 0.76）。所有标本均含有大量粘膜下层，可以对切除的肿瘤病变进行准确分期。 65% 的“带和圈套器”标本和 50% 的“注射、吸吮和切割”标本的基础上识别出固有肌层（P = 0.52）。 结论：“注射、吸吮和切割”和“带和圈套器”技术均可以通过 HGD 或 IMCA 获得巴雷特食管组织学标本的同等足够深度，并且都提供准确的病理分期。
Background and study aims: Endoscopic mucosal resection (EMR) has been carried out for high-grade dysplasia (HGD) and intramucosal carcinoma (IMCA) in Barrett's esophagus using two different cap-assisted techniques, the "inject, suck, and cut" and the "band and snare." Previous work has demonstrated comparable specimen diameters. However, the two techniques have not been previously compared with respect to depth of resection.Patients and methods: From a database of patients with Barrett's esophagus, we identified 40 consecutive specimens removed using EMR from patients with HGD or IMCA, 20 each from the "inject, suck, and cut" and the "band and snare" techniques. Specimens were evaluated and measured separately by two pathologists for greatest diameter and depth, and for the presence of submucosa and muscularis propria at the deepest margin of resection. Follow-up data were collected regarding clinical outcome and stricture formation.Results: The mean depth of the specimens from the two techniques was not significantly different (0.51 cm vs. 0.50 cm, P = 0.76). All specimens contained substantial submucosa, allowing accurate staging of the neoplastic lesions resected. Muscularis propria was identified at the base of 65% of the "band and snare" and 50% of the "inject, suck, and cut" specimens (P = 0.52).Conclusions: The "inject, suck, and cut" and "band and snare" techniques both yield equivalent adequate depth of histological specimens from Barrett's esophagus with HGD or IMCA, and both provide accurate pathological staging.