Kakushima N, Fujishiro M, Kodashima S, Kobayashi K, Tateishi A, Iguchi M, Imagawa A, Motoi T, Yahagi N, Omata M
Department of Gastroenterology, Faculty of Medicine, University of Tokyo, Hongo, Tokyo, Japan.
Endoscopy. 2006 Apr;38(4):412-5. doi: 10.1055/s-2006-925166.
We have previously reported that gastric ulcers artificially created by endoscopic submucosal dissection (ESD) would heal within 8 weeks regardless of size and location. The details of the healing process remain unclear, and we aimed to clarify the mechanism by histopathological investigation.
21 post-ESD ulcers were examined histopathologically, using surgically resected specimens from patients who had subsequently undergone gastrectomy due to submucosal invasion and/or lymphovascular infiltration by the tumor. The grade of ulcer, appearance of regenerative mucosa, scar formation, and extent of fibrosis were evaluated.
Fibrosis and wall thickening were observed from 2 weeks after ESD, but regenerative mucosa was not observed until 5 weeks. Among 12 patients who underwent gastrectomy later than 8 weeks after ESD, a mucosal defect was still observed in two patients. In these two patients the lesion was associated with severe fibrosis due to previous peptic ulcer or submucosal invasion by the lesion.
Size reduction in these ulcers occurs by contraction in the early phase, then regenerative mucosa covers the remaining mucosal defect within 8 weeks. If there is fibrosis under the lesion before ESD, there is a possibility that the artificially created ulcer will not heal within 8 weeks.
我们之前曾报道，通过内镜黏膜下剥离术（ESD）人工制造的胃溃疡，无论其大小和位置如何，均会在8周内愈合。愈合过程的细节尚不清楚，我们旨在通过组织病理学研究阐明其机制。
对21例ESD术后溃疡进行组织病理学检查，使用因肿瘤黏膜下浸润和/或淋巴管浸润而随后接受胃切除术的患者的手术切除标本。评估溃疡分级、再生黏膜外观、瘢痕形成及纤维化程度。
ESD术后2周观察到纤维化和胃壁增厚，但直到5周才观察到再生黏膜。在ESD术后8周以后接受胃切除术的12例患者中，有2例仍观察到黏膜缺损。在这2例患者中，病变与既往消化性溃疡或病变黏膜下浸润导致的严重纤维化有关。
这些溃疡在早期通过收缩实现尺寸减小，然后再生黏膜在8周内覆盖剩余的黏膜缺损。如果在ESD术前病变下方存在纤维化，则人工制造的溃疡有可能在8周内无法愈合。
