Endoscopic submucosal dissection for rectal epithelial neoplasia
Endoscopic submucosal dissection for rectal epithelial neoplasia
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DOI：
10.1055/s-2006-925398
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发表时间：
2006-05-01
期刊：
影响因子：
9.3
通讯作者：
Omata, M.
中科院分区：
文献类型：
--
作者：
Fujishiro, M.;Yahagi, N.;Omata, M.
背景和研究目的：内镜粘膜下剥离术（ESD）技术最近已被开发用于胃肿瘤的整块切除。出于肿瘤学原因以及为了提高患者的生活质量，可能需要对直肠肿瘤使用相同的技术。 患者和方法：连续纳入 35 名直肠肿瘤患者，这些患者术前诊断为大的上皮内肿瘤伴粘膜下纤维化或位于直肠皱襞。 ESD 采用与之前针对胃描述的相同技术进行，但进行了一些修改。评估治疗的疗效、并发症和随访结果。结果：整块切除和整块加R0切除的比率分别为88.6%（35例中的31例）和62.9%（35例中的22例）。 ESD 后，任何患者的血红蛋白水平下降幅度均不超过 2 g/dl。没有患者因 ESD 期间出血或 ESD 后便血而需要接受输血或接受急诊结肠镜检查。 ESD 期间发生穿孔的患者有 2 例（5.7%），在内镜下穿孔闭合后接受保守治疗。除 3 名接受额外手术的患者外，32 名患者中除 1 名外，在平均 36 个月（范围 12-60 个月）的随访期内均未出现复发。例外的是一名需要进行多部分切除的患者； ESD 2个月后发现的复发（残留）肿瘤是一个小腺瘤，再次进行内镜治疗。结论：ESD适用于直肠，效果良好，但该技术仍处于发展阶段，应告知患者潜在风险。
Background and Study Aims: The technique of endoscopic submucosal dissection (ESD) has recently been developed for en-bloc resection of gastric tumors. For oncological reasons and in order to improve the patients' quality of life, it may be desirable to use the same technique for rectal neoplasia.Patients and Methods: Thirty-five consecutive patients with rectal neoplasia who had a preoperative diagnosis of large intraepithelial neoplasias with submucosal fibrosis or located on the rectal folds were enrolled. ESD was carried out with the same technique previously described for the stomach, with some modifications. The efficacy, complications, and follow-up results of the treatment were assessed.Results: The rates of en-bloc resection and en-bloc plus R0 resection were 88.6% (31 of 35) and 62.9% (22 of 35), respectively. Hemoglobin levels did not drop by more than 2 g/dl in any of the patients after ESD. None of the patients had to receive blood transfusions or undergo emergency colonoscopy due to bleeding during ESD or hematochezia after ESD. Perforation during ESD occurred in two patients (5.7%), who were managed with conservative medical treatment after endoscopic closure of the perforation. Excluding three patients in whom additional surgery was carried out, all but one of 32 patients were free of recurrence during a mean follow-up period of 36 months (range 12-60 months). The exception was a patient in whom a multiple-piece resection was required; the recurrent (residual) tumor, found 2 months after ESD, was a small adenoma that was again treated endoscopically.Conclusions: ESD is applicable in the rectum with promising results, but the technique is still at a developmental stage and patients should be informed of the potential risks.