Curative endoscopic resection of early esophageal adenocarcinomas (Barrett's cancer)
Curative endoscopic resection of early esophageal adenocarcinomas (Barrett's cancer)
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DOI：
10.1016/j.gie.2006.04.033
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发表时间：
2007-01-01
影响因子：
7.7
通讯作者：
Stolte, Manfired
中科院分区：
文献类型：
--
作者：
Ell, Christian;May, Andrea;Stolte, Manfired
背景资料：鉴于Barrett食管腺癌发病率的增加以及与手术治疗相关的死亡率和高发病率，需要安全有效但侵入性较小的治疗方法。目的：评估内镜切除术在这些患者中的有效性和安全性。设计：单中心前瞻性研究。教学医院，1996年10月至2003年9月进行。患者：共100例连续患者（平均年龄：62.1 ± 10.9岁;范围：31-86岁）患有低风险食管腺癌（肉眼可见I、IIa、IIb和IIc型;病变直径达20 mm;粘膜病变未侵入淋巴管和静脉;组织学分级G1和G2）。内镜切除术与吸切technique.Main Outcome Measurements：Complete local remission.Results：共144例切除术（每例1.47例），无技术问题。无严重并发症发生，仅11例轻微并发症（眼睑下垂，Hb未下降> 2 g/dL;注射治疗）。在1.9个月（范围，1-18个月）和最多3次切除后，100例患者中有99例达到完全局部缓解。在平均36.7个月的随访期内，11%的患者发现复发或异时性癌，但所有这些病例均可能成功进行内镜切除术重复治疗。计算的5年生存率为98%。两名患者死于其他原因。局限性：非盲，nonrandomizedstudy.Conclusions：内镜切除术与低风险患者早期食管腺癌（巴雷特癌）的良好结局。
Background: In view of the increasing incidence of adenocarcinoma in Barrett's esophagus and the mortality and high morbidity rates associated with surgical therapy for this condition, safe and effective hut less invasive methods of treatment are needed.Objective: To evaluate efficacy and safety of endoscopic resection in these patients.Design: Single-center prospective study.Setting: Teaching hospital, conducted between October 1996 and September 2003.Patients: A total of 100 consecutive patients (mean age, 62.1 +/- 10.9 years; range, 31-86 years) with low-risk adenocarcinoma of the esophagus (macroscopic types I, Ila, Ilb, and IIc; lesion diameter up to 20 mm; mucosal lesion without invasion into lymph vessels and veins; and histologic grades G1 and G2) arising in Barrett's metaplasia.Interventions: Endoscopic resection with the suck-and-cut technique.Main Outcome Measurements: Complete local remission.Results: A total of 144 resections (1.47 per patient) were performed without technical problems. No major complications and only 11 minor ones (bleedings without decrease of Hb > 2 g/dL; treated with injection therapy) occurred. Complete local remission was achieved in 99 of the 100 patients after 1.9 months (range, 1-18 months) and a maximum of 3 resections. During a mean follow-up period of 36.7 months, recurrent or metachronous carcinomas were found in 11% of the patients, but successful repeat treatment with endoscopic resection was possible in all of these cases. The calculated 5-year survival rate was 98%. Two patients died of other causes.Limitations: Nonblinded, nonrandomized study.Conclusions: Endoscopic resection is associated with favorable outcomes for low-risk patients with early esophageal adenocarcinoma (Barrett's carcinoma).