Comparative Outcomes of Cap Assisted Endoscopic Resection and Endoscopic Submucosal Dissection in Dysplastic Barrett's Esophagus.
Comparative Outcomes of Cap Assisted Endoscopic Resection and Endoscopic Submucosal Dissection in Dysplastic Barrett's Esophagus.
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在发育异常的巴雷特食管中，帽辅助内窥镜切除和内窥镜粘膜下截面的比较结果。
DOI：
10.1016/j.cgh.2020.11.017
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发表时间：
2022-01
期刊：
影响因子：
--
通讯作者：
Iyer PG
中科院分区：
文献类型：
--
作者：
Codipilly DC;Dhaliwal L;Oberoi M;Gandhi P;Johnson ML;Lansing RM;Harmsen WS;Wang KK;Iyer PG
内镜切除术（ER）是内镜治疗Barrett食管（BE）伴异型增生和粘膜内腺癌（IMC）的重要组成部分。ER可通过帽辅助内镜粘膜切除术（cEMR）或内镜粘膜下剥离术（ESD）进行。我们比较了ESD与cEMR的组织学结局，随后进行消融。我们查询了2006年1月至2020年3月在我们机构接受cEMR和ESD消融术后的所有患者的前瞻性维护数据库，并提取了相关的人口统计学和临床数据。我们的主要结局包括异型增生完全缓解率（CRD）：监测组织学上无异型增生和肠上皮化生完全缓解率（CRIM）：无肠上皮化生。我们的次要结果包括并发症发生率。我们在研究中纳入了537例患者：456例接受cEMR，81例接受ESD。cEMR组和ESD组2年时CRD的累积概率分别为75.8%和85.6%（p< 0.01）。CRD的独立预测因素为：ESD（HR：2.38; p<0.01）和BE段长度较短（HR：1.11; p < 0.01）。cEMR组和ESD组2年时CRIM的累积概率分别为59.3%和50.6%（p>0.05）。CRIM的唯一独立预测因素是BE段较短（HR：1.16; p < 0.01）。接受ESD治疗的发育不良或IMC BE患者达到CRD的比率高于接受cEMR治疗的患者，尽管两组之间两年的CRIM率和并发症发生率相似。
Endoscopic resection (ER) is an important component of the endoscopic treatment of Barrett’s Esophagus (BE) with dysplasia and intramucosal adenocarcinoma (IMC). ER can be performed by cap assisted endoscopic mucosal resection (cEMR) or endoscopic submucosal dissection (ESD). We compared the histological outcomes of ESD versus cEMR, followed by ablation. We queried a prospectively maintained database of all patients undergoing cEMR and ESD followed by ablation at our institution from January 2006 to March 2020 and abstracted relevant demographic and clinical data. Our primary outcomes included the rate of complete remission of dysplasia (CRD): absence of dysplasia on surveillance histology and complete remission of intestinal metaplasia (CRIM): absence of intestinal metaplasia. Our secondary outcome included complication rates. We included 537 patients in the study: 456 who underwent cEMR and 81 who underwent ESD. The cumulative probabilities of CRD at 2 years were 75.8% and 85.6% in the cEMR and ESD groups (p< 0.01). Independent predictors of CRD were: ESD (HR: 2.38; p<0.01) and shorter BE segment length (HR: 1.11; p < 0.01). The cumulative probabilities of CRIM at 2 years were 59.3% and 50.6% in cEMR and ESD groups respectively (p>0.05). The only independent predictor of CRIM was a shorter BE segment (HR: 1.16; p < 0.01). BE patients with dysplasia or IMC undergoing ESD reach CRD at higher rates than those treated with cEMR, though CRIM rates at two years and complication rates were similar between the two groups.
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影响因子：
12.6
作者：
Wani, Sachin;Mathur, Sharad C.;Sharma, Prateek
通讯作者：
Sharma, Prateek
影响因子：
158.5
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6
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作者：
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影响因子：
29.4
作者：
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通讯作者：
REID, BJ