浅表性食管病变内镜黏膜切除术后的食管狭窄

Esophageal stenosis after endoscopic mucosal resection of superficial esophageal lesions.

作者信息

Katada Chikatoshi, Muto Manabu, Manabe Tetsuro, Boku Narikazu, Ohtsu Atsushi, Yoshida Shigeaki

机构信息

The Division of Digestive Endoscopy and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan.

出版信息

Gastrointest Endosc. 2003 Feb;57(2):165-9. doi: 10.1067/mge.2003.73.

DOI:10.1067/mge.2003.73

PMID:12556777

Abstract

BACKGROUND

Although bleeding and perforation are generally recognized major complications of endoscopic mucosal resection, esophageal stricture after endoscopic mucosal resection has not been well studied. Factors associated with the occurrence and severity of esophageal stenosis after endoscopic mucosal resection were investigated.

METHODS

Two hundred sixteen superficial esophageal lesions in 137 consecutive patients who underwent endoscopic mucosal resection from February 1993 through March 2001 were retrospectively studied. The circumferential extent of the mucosal defect after endoscopic mucosal resection was classified into 4 groups: under one fourth, one fourth to one half, one half to three fourths, and over three fourths. The longitudinal length of the mucosal defect was also evaluated. Stenosis was diagnosed when a standard endoscope (11-mm diameter) could not be passed through the stricture.

RESULTS

Esophageal stenosis developed after endoscopic mucosal resection of 13 lesions (6.0%). In all these cases endoscopic mucosal resection resulted in a mucosal defect that involved over three fourths of the luminal circumference. In the subgroup of patients with mucosal defects involving over three fourths of the circumference, those with a mucosal defect over 30 mm long required more frequent balloon dilatation (mean 8 [4.3] times) and the stenosis was of longer duration (mean 16 [17.7] months) than those with defects 30 mm or less in length (respectively, 1 [0.6] times and 2 [1.9] months).

CONCLUSIONS

A circumferential mucosal defect involving over three fourths the circumference of the esophagus after endoscopic mucosal resection was significantly associated with the subsequent development of esophageal stenosis. In addition, mucosal defects longer than 30 mm were associated with greater severity of stenosis. When endoscopic mucosal resection is performed for superficial esophageal lesions, removal of excess mucosa should be avoided.

摘要

背景

尽管出血和穿孔是公认的内镜黏膜切除术的主要并发症，但内镜黏膜切除术后食管狭窄尚未得到充分研究。本研究旨在调查与内镜黏膜切除术后食管狭窄的发生及严重程度相关的因素。

方法

回顾性研究了1993年2月至2001年3月期间连续137例接受内镜黏膜切除术的患者的216处浅表食管病变。内镜黏膜切除术后黏膜缺损的周向范围分为4组：小于四分之一、四分之一至二分之一、二分之一至四分之三、超过四分之三。同时评估黏膜缺损的纵向长度。当标准内镜（直径11毫米）无法通过狭窄部位时，诊断为狭窄。

结果

13处病变（6.0%）在内镜黏膜切除术后发生食管狭窄。所有这些病例中，内镜黏膜切除均导致黏膜缺损累及管腔周长的四分之三以上。在黏膜缺损累及周长四分之三以上的患者亚组中，黏膜缺损长度超过30毫米的患者比缺损长度30毫米及以下的患者需要更频繁的球囊扩张（平均8[4.3]次对1[0.6]次），且狭窄持续时间更长（平均16[17.7]个月对2[1.9]个月）。