Yamamoto Hironori, Kawata Hiroshi, Sunada Keijiro, Satoh Kiichi, Kaneko Yoshinari, Ido Kenichi, Sugano Kentaro
Department of Gastroenterology, Jichi Medical School, Tochigi, Japan.
Gastrointest Endosc. 2002 Oct;56(4):507-12. doi: 10.1067/mge.2002.128108.
Circumferential mucosal incision around a lesion is effective for reliable endoscopic mucosal resection. However, mucosal incision with a needle knife is difficult, even with submucosal injection of normal saline solution. To make needle-knife incision easier and safer, sodium hyaluronate has been used rather than normal saline solution. The aim of this study was to evaluate the clinical outcome of endoscopic mucosal resection with circumferential mucosal incision assisted by submucosal injection of sodium hyaluronate.
For 70 gastric lesions treated by submucosal injection of sodium hyaluronate, the size of the lesion and the resection specimen, the en bloc resection rate, complications, and local recurrence during follow-up were assessed.
The mean size of the lesions and resection specimens were, respectively, 19.9 mm and 30.0 mm. The en bloc resection rates were 89% (42/47) for lesions up to 20 mm in diameter and 48% (11/23) for those greater than 20 mm (1-20 mm vs. >20 mm, p = 0.0004). Three patients underwent surgery because of invasive cancer in the EMR specimen. During follow-up (median 14 months, range 3-38 months), 2 recurrent lesions were found. No major complication occurred.
Submucosal injection of sodium hyaluronate is a reliable method with a high success rate for en bloc resection of lesions up to 20 mm in diameter. Mucosal incision with a needle knife can be performed safely with submucosal injection of sodium hyaluronate.
围绕病变进行环形黏膜切开术对于可靠的内镜黏膜切除术是有效的。然而，即使在黏膜下注射生理盐水，使用针刀进行黏膜切开也很困难。为了使针刀切开更容易、更安全，已使用透明质酸钠而非生理盐水。本研究的目的是评估在透明质酸钠黏膜下注射辅助下进行环形黏膜切开的内镜黏膜切除术的临床效果。
对于70例接受透明质酸钠黏膜下注射治疗的胃病变，评估病变大小、切除标本大小、整块切除率、并发症以及随访期间的局部复发情况。
病变和切除标本的平均大小分别为19.9毫米和30.0毫米。直径达20毫米的病变整块切除率为89%（42/47），直径大于20毫米的病变整块切除率为48%（11/23）（1 - 20毫米与>20毫米，p = 0.0004）。3例患者因内镜黏膜切除术标本中存在浸润性癌而接受手术。在随访期间（中位时间14个月，范围3 - 38个月），发现2例复发病变。未发生重大并发症。
透明质酸钠黏膜下注射是一种可靠的方法，对于直径达20毫米的病变整块切除成功率高。在透明质酸钠黏膜下注射的情况下，使用针刀进行黏膜切开可安全进行。
