Soejima T, Nishimura H, Ejima Y, Sasaki R, Yoden E, Yamada K, Sugimura K
Department of Radiology, Kobe Graduate University School of Medicine, Kobe, Japan.
Dis Esophagus. 2002;15(3):266-8. doi: 10.1046/j.1442-2050.2002.00257.x.
Esophageal ulcer is one of the most important late complications of the esophagus treated with radiation therapy, especially with intraluminal brachytherapy. We encountered a patient with esophageal cancer treated with external radiation therapy and intraluminal brachytherapy, who developed radiation ulcer and who had severe dysphagia soon after endoscopic biopsy of the ulcer edge. A 55-year-old man was diagnosed as esophageal cancer without symptoms. He received 60 Gy/30 Fr of external radiation therapy and 12 Gy/3 Fr of intraluminal brachytherapy at a point of 5 mm in depth from the mucosa surface. He developed an asymptomatic esophageal ulcer 13 months after treatment, and endoscopic biopsy was obtained from the edge of the ulcer. Thereafter, swallowing difficulties appeared, and endoscopy revealed severe esophageal stenosis and a deep ulcer. A possibility that the biopsy contributed to worsening the ulcer can be considered. Except for cases where relapse is apparent, endoscopic biopsy is considered to be avoided.
食管溃疡是放射治疗尤其是腔内近距离放射治疗食管后最重要的晚期并发症之一。我们遇到一名接受外照射放疗和腔内近距离放射治疗的食管癌患者，该患者出现了放射性溃疡，并且在溃疡边缘进行内镜活检后不久出现了严重吞咽困难。一名55岁男性被诊断为无症状食管癌。他在距黏膜表面5毫米深处接受了60 Gy/30次分割的外照射放疗和12 Gy/3次分割的腔内近距离放射治疗。治疗13个月后，他出现了无症状食管溃疡，并从溃疡边缘进行了内镜活检。此后，出现吞咽困难，内镜检查显示严重食管狭窄和深部溃疡。可以考虑活检导致溃疡恶化的可能性。除了复发明显的情况外，应避免进行内镜活检。
