Endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms.
Endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms.
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DOI：
10.4291/wjgp.v3.i2.44
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发表时间：
2012-04-15
期刊：
影响因子：
--
通讯作者：
Akiho, Hirotada
中科院分区：
文献类型：
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作者：
Honda, Kuniomi;Akiho, Hirotada
内镜下切除术是治疗非侵袭性食管鳞状细胞肿瘤（ESCNs）的有效方法。内镜下黏膜切除术（EMR）已被用于局限性小的ESCNs，作为手术治疗的替代方法，因为它与食管切除术相比，疗效相似且侵袭性更小。然而，EMR在切除大小上存在局限性，因此对于大的病变需进行分片切除，这导致组织学评估不准确以及局部复发率高。内镜下黏膜下剥离术（ESD）在日本已发展成为ESCNs的标准内镜下切除技术之一。ESD能够将食管病变整块切除，无论其大小如何，因此其局部复发率比EMR低。食管ESD新器械的研发以及最佳策略的建立使得穿孔等并发症比预期的要少。然而，当切除面积大于食管腔的四分之三，特别是当病变累及整个食管周径时，ESD术后可能会发生食管狭窄；这种狭窄需要多次内镜下球囊扩张。最近，据报道口服泼尼松龙对预防ESD术后狭窄有用。此外，对于有淋巴结转移风险的食管黏膜下癌，放化疗（CRT）与ESD联合可能是一种替代治疗方法，因为食管切除术的侵袭性极强；CRT的局部复发率比食管切除术高，但侵袭性更小。ESD将来可能在浅表性食管鳞状细胞肿瘤的治疗中发挥核心作用。
Endoscopic resection is an effective treatment for non-invasive esophageal squamous cell neoplasms (ESCNs). Endoscopic mucosal resection (EMR) has been developed for small localized ESCNs as an alternative to surgical therapy because it shows similar effectiveness and is less invasive than esophagectomy. However, EMR is limited in resection size and therefore piecemeal resection is performed for large lesions, resulting in an imprecise histological evaluation and a high frequency of local recurrence. Endoscopic submucosal dissection (ESD) has been developed in Japan as one of the standard endoscopic resection techniques for ESCNs. ESD enables esophageal lesions, regardless of their size, to be removed en bloc and thus has a lower local recurrence rate than EMR. The development of new devices and the establishment of optimal strategies for esophageal ESD have resulted in fewer complications such as perforation than expected. However, esophageal stricture after ESD may occur when the resected area is larger than three-quarters of the esophageal lumen or particularly when it encompasses the entire circumference; such a stricture requires multiple sessions of endoscopic balloon dilatation. Recently, oral prednisolone has been reported to be useful in preventing post-ESD stricture. In addition, a combination of chemoradiotherapy (CRT) and ESD might be an alternative therapy for submucosal esophageal cancer that has a risk of lymph node metastasis because esophagectomy is extremely invasive; CRT has a higher local recurrence rate than esophagectomy but is less invasive. ESD is likely to play a central role in the treatment of superficial esophageal squamous cell neoplasms in the future.