Endoscopic submucosal dissection with a combination of small-caliber-tip transparent hood and flex knife for superficial esophageal neoplasia. Is it safe for elderly patients?
Endoscopic submucosal dissection with a combination of small-caliber-tip transparent hood and flex knife for superficial esophageal neoplasia. Is it safe for elderly patients?
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DOI：
10.1007/s00464-010-0907-3
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发表时间：
2010-09-01
影响因子：
3.1
通讯作者：
Fujita, Yoshiyuki
中科院分区：
文献类型：
--
作者：
Ishii, Naoki;Uchida, Shino;Fujita, Yoshiyuki
背景内镜下黏膜下剥离术（ESD）治疗食管肿瘤的安全性和有效性尚未在老年患者中得到充分研究。方法2006年5月至2009年6月，采用小口径透明罩加柔性刀ESD治疗老年食管浅表肿瘤53例，其中老年组33例，采用小口径透明罩加柔性刀ESD治疗，老年组33例，采用小口径透明罩加柔性刀ESD治疗（70岁或以上：23例患者25处病变）和非老年组（年龄小于70岁：25例患者28处病变）。结果老年组脑梗死或心肺疾病史、抗血小板药物或抗凝剂使用率明显高于对照组（分别为p0.0050和p0.0013）。老年组和非老年组的中位手术时间分别为93 +/- 53（范围，42-235）min和95 +/- 55（范围，40-230）min（p 0.73）。肿瘤和切除标本的中位尺寸分别为14 +/- 11（范围，5-45）mm和15 +/- 17（范围，5-83）mm（p 0.56），以及35 +/- 12（范围，18-60）mm和38 +/- 17（范围，18-90）mm（p 0.38）。各组的整块切除率均为100%。非老年组ESD后第二天的体温和白色血细胞计数显著高于老年组（分别为p 0.0087和p 0.0043）。各组均无术后出血、穿孔等并发症。中位随访时间为23 +/- 10（范围，4-35）个月，在老年group.Conclusions ESD与小口径尖端透明罩和柔性刀相结合，是一种安全有效的治疗浅表食管肿瘤的老年人和非老年患者。
Background Safety and efficacy of endoscopic submucosal dissection (ESD) for esophageal neoplasias have not been adequately investigated in elderly patients. This study was designed to evaluate the safety and efficacy of ESD for esophageal neoplasias in elderly patients.Methods Fifty-three superficial esophageal neoplasias treated with ESD using a combination of small-caliber-tip transparent hood and flex knife from May 2006 to June 2009 were divided into elderly group (aged 70 years or older: 25 lesions in 23 patients) and nonelderly group (younger than aged 70 years: 28 lesions in 25 patients). Therapeutic efficacy, complications, and follow-up results were evaluated retrospectively.Results The history of cerebral infarction or cardiopulmonary disease and the usage of antiplatelet agents or anticoagulants were significantly higher in elderly group (p 0.0050 and p 0.0013, respectively). Median procedural times in the elderly group and the nonelderly group were 93 +/- 53 (range, 42-235) min and 95 +/- 55 (range, 40-230) min (p 0.73), respectively. Median sizes of the neoplasias and the resected specimens were 14 +/- 11 (range, 5-45) mm and 15 +/- 17 (range, 5-83) mm (p 0.56), and 35 +/- 12 (range, 18-60) mm and 38 +/- 17 (range, 18-90) mm (p 0.38), respectively. En bloc resection rate was 100% in each group. Body temperature and white blood cell counts of the next day after ESD were significantly higher in the nonelderly group than in the elderly group (p 0.0087 and p 0.0043, respectively). There were no complications, such as postoperative bleeding or perforation, in each group. The median follow-up period of 23 +/- 10 (range, 4-35) months in the elderly group revealed no local or distant metastasis.Conclusions ESD with a combination of small-caliber-tip transparent hood and flex knife is a safe and effective treatment for superficial esophageal neoplasia in elderly and nonelderly patients.