Endoscopic Submucosal Dissection is an Effective and Safe Therapy for Early Gastric Neoplasms A Multicenter Feasible Study
Endoscopic Submucosal Dissection is an Effective and Safe Therapy for Early Gastric Neoplasms A Multicenter Feasible Study
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DOI：
10.1097/mcg.0b013e31822f3988
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发表时间：
2012-02-01
影响因子：
2.9
通讯作者：
Koike, Kazuhiko
中科院分区：
文献类型：
--
作者：
Sugimoto, Takafumi;Okamoto, Makoto;Koike, Kazuhiko
背景和目的：引入内镜粘膜下剥离术（ESD）技术来获取大型早期胃肠道肿瘤的整块标本。 ESD 的缺点是技术难度大，因此并发症发生率较高。在这项多中心研究中，我们调查了连续患者的ESD治疗结果。方法：从2002年1月至2008年12月，东京4个机构的6名内窥镜医师连续使用ESD手术治疗了418例患者的485例早期胃肿瘤。对人口统计学、肿瘤部位、治疗结果和并发症发生率进行分析。结果：整块切除、完整整块切除、粘膜下侵犯和分片切除率分别为93.6%、85.4%、10.9%和5.4%。多因素分析显示，上部病灶整块切除率低于下部病灶（P < 0.01），较大病灶整块切除率较低（> 30mm，P < 0.05；20～30mm，P < 0.05），有疤痕病灶整块切除率较低（P < 0.01）。较大病灶（> 30mm，P < 0.01；20 至 29mm，P < 0.01）迟发性出血的发生率独立高于小病灶（< 20 mm）。机构和内窥镜医师不是整块切除和并发症的危险因素。结论：当由训练有素的内窥镜医师进行时，ESD 是治疗早期胃肿瘤的一种有效且安全的疗法。内镜医师应认识到进行 ESD 整块切除上部病灶的难度，以及病灶大小 > 2 cm 时延迟出血的风险。
Background and Aim: The technique of endoscopic submucosal dissection (ESD) was introduced to obtain en bloc specimens of large early gastrointestinal neoplasms. The drawback of ESD is its technical difficulty and, consequently, its higher rate of complication. In this multicenter study, we investigated the therapeutic outcomes of ESD in consecutive patients.Methods: From January 2002 to December 2008, 485 early gastric neoplasms in 418 patients were consecutively treated by using ESD procedure performed by 6 endoscopists in 4 institutions in Tokyo. Demorgraphics, tumor location, therapeutic outcomes, and complication rates were analyzed.Results: The rates of en bloc resection, complete en bloc resection, submucosal invasion, and piecemeal resection were 93.6%, 85.4%, 10.9%, and 5.4%, respectively. In multivariate analysis, the en bloc resection rate was independently lower in lesions in upper portion than in lower portion (P < 0.01), lower in larger lesions (> 30mm, P < 0.05; 20 to 30mm, P < 0.05), and lower in lesions with a scar (P < 0.01). Delayed bleeding occurrence was independently high in larger lesions (> 30mm, P < 0.01; 20 to 29mm, P < 0.01) than in small lesions (< 20 mm). Institution and endoscopists were not risk factors of en bloc resection and complicationsConclusions: ESD is an effective and safe therapy in the management of early gastric neoplasms when performed by well-trained endoscopists. Endoscopists should recognize the difficulty to perform ESD for en bloc resection of upper lesion, and the risk of delayed bleeding in cases of lesions > 2 cm in size.