Takeo Y, Yoshida T, Shigemitu T, Yanai H, Hayashi N, Okita K
First Department of Internal Medicine, Yamaguchi University School of Medicine, 1-1-1, Minami-Kogushi, Ube-City, Yamaguchi-Ken, Japan.
Hepatogastroenterology. 2001 Mar-Apr;48(38):453-7.
BACKGROUND/AIMS: Advances in diagnostic technology have led to increased detection of early esophageal cancer, which is suitable for endoscopic treatment. We performed endoscopic esophageal mucosal resection of such cancer and dysplasia using the endoscopic esophageal mucosal resection tube and evaluated the clinical benefit of this technique.
Twenty-nine patients with esophageal mucosal cancer (27 cases with 33 lesions) or dysplasia (2 cases with 2 lesions) diagnosed between September 1992 and March 1998 were assessed endoscopically for the depth and extent of invasion by double staining with toluidine blue and iodine. Endoscopic ultrasonography was also performed to assess the depth of invasion in 22 cases with 22 lesions.
The 35 esophageal lesions comprised 27 esophageal carcinomas and 8 areas of dysplasia. Twenty of the 35 lesions were resected en bloc and 15 were resected piecemeal. Subsequent surgery was performed for 5 cases with 7 lesions out of 10 cases with 15 lesions that were histopathologically diagnosed as m3 or more invasive. No recurrence has been detected in 24 evaluable cases (including 1 who died of another disease, 2 in whom surgery could not be performed due to complications, and 3 who refused subsequent surgery). No patients died of esophageal cancer after a mean follow-up period of 30.9 +/- 18.9 months. The 4-year survival rate was 100% in the m2 or less invasive group of 19 cases with 20 lesions, 75% in the m3 or higher invasive group of 5 cases with 8 lesions and 100% in the surgery group of 5 cases with 7 lesions (NS). No serious complications occurred except for 1 patient. Circumferential mucosal resection was done in this patient, resulting in esophageal stenosis, which responded to esophageal dilation.
Esophageal mucosal resection using the endoscopic esophageal mucosal resection tube is safe and beneficial for early esophageal cancer and dysplasia.
背景/目的：诊断技术的进步使得早期食管癌的检出率增加，而早期食管癌适合内镜治疗。我们使用内镜食管黏膜切除术管对这类癌症和发育异常进行了内镜下食管黏膜切除术，并评估了该技术的临床益处。
对1992年9月至1998年3月间诊断为食管黏膜癌（27例，33处病变）或发育异常（2例，2处病变）的29例患者，通过甲苯胺蓝和碘双重染色进行内镜下评估浸润深度和范围。还对22例有22处病变的患者进行了内镜超声检查以评估浸润深度。
35处食管病变包括27例食管癌和8处发育异常区域。35处病变中的20处整块切除，15处分片切除。在15处病变经组织病理学诊断为m3或更高浸润性的10例患者中，有7处病变的5例患者随后接受了手术。在24例可评估病例中（包括1例死于其他疾病、2例因并发症无法进行手术以及3例拒绝后续手术的患者）未检测到复发。平均随访30.9±18.9个月后，无患者死于食管癌。19例有20处病变的m2或更低浸润性组的4年生存率为100%，5例有8处病变的m3或更高浸润性组的4年生存率为75%，5例有7处病变的手术组的4年生存率为100%（无显著性差异）。除1例患者外未发生严重并发症。该患者进行了环形黏膜切除术，导致食管狭窄，经食管扩张治疗有效。
使用内镜食管黏膜切除术管进行食管黏膜切除术对早期食管癌和发育异常是安全且有益的。
