Endoscopic submucosal dissection of early gastric cancer
Endoscopic submucosal dissection of early gastric cancer
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DOI：
10.1159/000111484
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发表时间：
2008-01-01
期刊：
影响因子：
3.2
通讯作者：
Takizawa, Kohei
中科院分区：
文献类型：
--
作者：
Tanaka, Masaki;Ono, Hiroyuki;Takizawa, Kohei
无淋巴结转移的早期胃癌(EGC)的内窥镜黏膜切除术(EMR)于20世纪80年代在日本发展起来，近20年来一直是EGC的标准治疗方法之一。最近，日本开发的几种埃米尔技术已经被西方国家接受和实施。这些Emir技术安全有效，但不适用于较大的病变。由于无法切除对准确诊断肿瘤深度非常重要的I段大病灶，大病灶病例局部复发率增加。20世纪90年代末，一种使用新开发的内窥镜刀具的创新手术--内窥镜黏膜下剥离(ESD)--被开发出来，使整块切除大病变成为可能。从理论上讲，ESD对肿瘤大小没有限制，因此在某些情况下有望取代手术治疗。虽然ESD在短时间内在日本各地推广，但仍存在一些缺点，如与传统的EMR方法相比，ESD的并发症发生率更高，对内窥镜技术的要求更高。本文对EGC的内窥镜适应证、手术方法、并发症及治疗结果进行了综述。版权所有(C)2008 S.Karger AG，巴塞尔。
Endoscopic mucosal resection (EMR) of early gastric cancer (EGC) without any risk of lymph node metastasis was developed in Japan in the 1980s, and it has been one of the standard treatments of EGC for nearly 20 years. Recently, several EMIR techniques developed in Japan have been accepted and done in Western countries. These EMIR techniques are safe and efficacious but unsuitable for large lesions. Because we could not remove a large lesion in I fragment, which was very important for the precise diagnosis of tumor depth, local recurrence increased in large-lesion cases. An innovative procedure using newly developed endoscopic knives, called endoscopic submucosal dissection (ESD), was developed in the late 1990s, which made it possible to remove a large lesion en bloc. Theoretically, ESD has no limitation with respect to tumor size; therefore, it is expected to replace the surgical treatment in some situations. Although ESD has spread throughout Japan within a short period, there remain several disadvantages, such as a higher incidence of complications and a requirement of higher endoscopic skills compared to those of conventional EMR methods. The endoscopic indications, procedures, complications and treatment outcomes of the ESD of EGC are described in this review. Copyright (c) 2008 S. Karger AG, Basel.