与条状活检相比，使用带有倾斜抽吸式黏膜切除术装置的电子病历系统对浅表食管癌患者的有效性。

Usefulness of EMR with an oblique aspiration mucosectomy device compared with strip biopsy in patients with superficial esophageal cancer.

作者信息

Tanabe Satoshi, Koizumi Wasaburo, Mitomi Hiroyuki, Kitamura Tadashi, Tahara Kumiko, Ichikawa Junko, Higuchi Katsuhiko, Sasaki Tohru, Nakayama Norisuke, Kida Mitsuhiro, Saigenji Katsunori

机构信息

Current affiliations: Department of Gastroenterology and Pathology, Kitasato University East Hospital, Sagamihara, Kanagawa, Japan.

出版信息

Gastrointest Endosc. 2004 Apr;59(4):558-63. doi: 10.1016/s0016-5107(03)02864-5.

DOI:10.1016/s0016-5107(03)02864-5

PMID:15044899

Abstract

BACKGROUND

EMR is now widely accepted as a treatment option for superficial esophageal cancer. Endoscopic oblique aspiration mucosectomy with an oblique aspiration mucosectomy device was performed, and the results were compared retrospectively with those of conventional strip biopsy.

METHODS

Strip biopsy (April 1991 through October 1999) or endoscopic oblique aspiration mucosectomy (November 1999 through December 2002) was performed in a consecutive series of patients with superficial esophageal squamous-cell carcinoma. Variables assessed were size of resection specimens, rate of complete resection, and complications.

RESULTS

Of the consecutive series of 66 patients with superficial esophageal cancer, 27 underwent strip biopsy and 39 had endoscopic oblique aspiration mucosectomy. The two groups were similar with respect to age, gender, and lesion macroscopic appearance. The endoscopic oblique aspiration mucosectomy group had a significantly greater mean depth of tumor invasion and had significantly more large lesions vs. the strip biopsy group. The mean longest diameter of resection specimens was significantly greater with endoscopic oblique aspiration mucosectomy (23.9 [5.2] mm) than with strip biopsy (15.2 [4.9] mm) (p<0.001). The en bloc resection rate was 33.3% (9/27) in the strip biopsy group and 46.2% (18/39) in the endoscopic oblique aspiration mucosectomy group (p=0.322). Despite larger lesion size in the endoscopic oblique aspiration mucosectomy group, the complete resection rate was similar between the strip biopsy (70.4%) and endoscopic oblique aspiration mucosectomy (74.4%) groups (p=0.783). The complete resection rate for lesions 30 mm or greater in diameter was slightly but not significantly higher in the endoscopic oblique aspiration mucosectomy group (84.4%) compared with the strip biopsy group (70.4%) (p>0.999). With respect to complications, the rates of bleeding and submucosal hematoma were similar. Esophageal stenosis occurred after the procedure in 3 patients in the endoscopic oblique aspiration mucosectomy group. All were managed by endoscopic dilation, and symptoms improved.

CONCLUSIONS

Endoscopic oblique aspiration mucosectomy is safe and effective for the treatment of superficial esophageal cancer.

摘要

背景

内镜黏膜切除术（EMR）现已被广泛接受为浅表性食管癌的一种治疗选择。采用倾斜式抽吸黏膜切除装置进行内镜下倾斜式抽吸黏膜切除术，并将结果与传统条带活检的结果进行回顾性比较。

方法

对一系列连续性浅表性食管鳞状细胞癌患者进行条带活检（1991年4月至1999年10月）或内镜下倾斜式抽吸黏膜切除术（1999年11月至2002年12月）。评估的变量包括切除标本的大小、完整切除率和并发症。

结果

在这一系列连续性66例浅表性食管癌患者中，27例行条带活检，39例行内镜下倾斜式抽吸黏膜切除术。两组在年龄、性别和病变宏观外观方面相似。内镜下倾斜式抽吸黏膜切除术组的肿瘤浸润平均深度显著更深，与条带活检组相比，大病变更多。内镜下倾斜式抽吸黏膜切除术的切除标本平均最长直径（23.9 [5.2] mm）显著大于条带活检（15.2 [4.9] mm）（p<0.001）。条带活检组的整块切除率为33.3%（9/27），内镜下倾斜式抽吸黏膜切除术组为46.2%（18/39）（p = 0.322）。尽管内镜下倾斜式抽吸黏膜切除术组的病变较大，但条带活检组（70.4%）和内镜下倾斜式抽吸黏膜切除术组（74.4%）的完整切除率相似（p = 0.783）。直径30 mm或更大病变的完整切除率在内镜下倾斜式抽吸黏膜切除术组（84.4%）略高于条带活检组（70.4%），但差异无统计学意义（p>0.999）。关于并发症，出血和黏膜下血肿的发生率相似。内镜下倾斜式抽吸黏膜切除术组有3例患者术后发生食管狭窄。均通过内镜扩张处理，症状改善。