Management of superficial Barrett's epithelium-related neoplasms by endoscopic mucosal resection - Clinicopathologic analysis of 27 cases
Management of superficial Barrett's epithelium-related neoplasms by endoscopic mucosal resection - Clinicopathologic analysis of 27 cases
复制标题
DOI：
10.1097/01.pas.0000154129.87219.fa
复制
发表时间：
2005-05-01
影响因子：
5.6
通讯作者：
Lauwers, GY
中科院分区：
文献类型：
--
作者：
Mino-Kenudson, M;Brugge, WR;Lauwers, GY
内镜粘膜切除术（EMR）是一种相对较新的腔内治疗技术，发病率低，迄今为止没有死亡率的报道，被提倡用于治疗Barrett食管（BE）相关的浅表肿瘤。然而，最近的研究将其成功率向下修正，特别是关于实现完全切除的能力。为了评价什么仍然是一种不断发展的技术，我们分析了27例食管EMR（18例患者20处病变）的经验。我们的目标是通过将初始活检和EMR前内镜超声（EUS）分期与最终组织学诊断和分期相关联，分别评估EMR的诊断、分期和治疗优势。肿瘤组织的持续/复发也与切除的边缘状态相关。肿瘤的平均大小为11 mm，包括低度发育不良（n = 2）、高度发育不良（n = 8）、粘膜内癌（n =14）和粘膜下浸润性癌（n = 3）。EUS正确报告了70%的粘膜内或粘膜下病变，而18%的病例分期过高，12%的病例分期过低。活检诊断与EMR诊断符合率为63%。活检低估了21%病例的病变级别。EMR显示16%的病例的组织学分级低于活检。只有4%的病例在显微镜下完全切除。EMR后4至63个月（平均23个月），10处病变（9例患者）中未观察到残留/复发疾病。然而，9个病灶（8例患者）在治疗后28天至25个月（平均6个月）持续/复发; 56%的外侧边缘阳性和深边缘阴性的病例持续/复发。然而，86%深切缘阳性的EMR在随访活检时显示残留肿瘤/复发。总之，我们观察到EMR与活检和EUS相比提供了更好的诊断和分期。这是一个显着的优势，因为它可以改变患者的管理。然而，频繁的不完全切除和高持续性/复发是需要持续内镜监测的重要陷阱。
Endoscopic mucosal resection (EMR), a relatively new endoluminal therapeutic technique with low morbidity and no mortality reported to date, is advocated for the treatment of Barrett's esophagus (BE)-related superficial neoplasms. However, recent studies revise its success downward, particularly regarding the ability to achieve complete excision. To evaluate what remains an evolving technique, we analyzed our experience with a series of 27 esophageal EMRs (20 lesions in 18 patients). Our goal was to evaluate the diagnostic, staging, and therapeutic advantages of EMR separately by correlating the initial biopsies and pre-EMR endoscopic ultrasound (EUS) staging with the final histologic diagnoses and stage. Persistence/recurrence of neoplastic tissue was also correlated with the margin status of the resections. The mean size of the neoplasms, which included low-grade dysplasias (n = 2), high-grade dysplasias (n = 8), intramucosal carcinomas (n =14), and submucosal invasive carcinomas (n = 3), was 11 mm. EUS correctly reported an intramucosal or submucosal lesion in 70% of the cases while it overstaged 18% and understaged 12% of the cases. The biopsy diagnosis corresponded to the EMR diagnosis in 63% of the cases. The biopsy underestimated the grade of the lesion in 21% of the cases. EMR revealed a lower histologic grade compared with the biopsy in 16% of the cases. The resection was microscopically complete in only 4% of the cases. No residual/recurrent disease was observed in 10 lesions (9 patients) at 4 to 63 months (mean, 23 months) post-EMR. However, 9 lesions (8 patients) persisted/recurred 28 days to 25 months (mean, 6 months) after treatment; 56% of the cases with positive lateral margin(s) and negative deep margin persisted/recurred. However, 86% of the EMRs with positive deep margin showed residual tumor/recurrence on follow-up biopsies. In conclusion, we observed that EMR offers improved diagnosis and staging as compared with biopsy and EUS. This is a significant advantage since it can modify patients' management. However, frequent incompleteness of resection and high persistence/recurrence are significant pitfalls that dictate continued endoscopic surveillance.