Ell Christian, May Andrea, Pech Oliver, Gossner Liebwin, Guenter Erwin, Behrens Angelika, Nachbar Lars, Huijsmans Josephus, Vieth Michael, Stolte Manfred
Department of Internal Medicine II, HSK Wiesbaden, Teaching Hospital of the University of Mainz, Wiesbaden, Germany.
Gastrointest Endosc. 2007 Jan;65(1):3-10. doi: 10.1016/j.gie.2006.04.033.
In view of the increasing incidence of adenocarcinoma in Barrett's esophagus and the mortality and high morbidity rates associated with surgical therapy for this condition, safe and effective but less invasive methods of treatment are needed.
To evaluate efficacy and safety of endoscopic resection in these patients.
Single-center prospective study.
Teaching hospital, conducted between October 1996 and September 2003.
A total of 100 consecutive patients (mean age, 62.1 +/- 10.9 years; range, 31-86 years) with low-risk adenocarcinoma of the esophagus (macroscopic types I, IIa, IIb, and IIc; lesion diameter up to 20 mm; mucosal lesion without invasion into lymph vessels and veins; and histologic grades G1 and G2) arising in Barrett's metaplasia.
Endoscopic resection with the suck-and-cut technique.
Complete local remission.
A total of 144 resections (1.47 per patient) were performed without technical problems. No major complications and only 11 minor ones (bleedings without decrease of Hb >2 g/dL; treated with injection therapy) occurred. Complete local remission was achieved in 99 of the 100 patients after 1.9 months (range, 1-18 months) and a maximum of 3 resections. During a mean follow-up period of 36.7 months, recurrent or metachronous carcinomas were found in 11% of the patients, but successful repeat treatment with endoscopic resection was possible in all of these cases. The calculated 5-year survival rate was 98%. Two patients died of other causes.
Nonblinded, nonrandomized study.
Endoscopic resection is associated with favorable outcomes for low-risk patients with early esophageal adenocarcinoma (Barrett's carcinoma).
鉴于巴雷特食管腺癌的发病率不断上升，以及与这种疾病手术治疗相关的死亡率和高发病率，需要安全、有效且侵入性较小的治疗方法。
评估内镜切除术在这些患者中的疗效和安全性。
单中心前瞻性研究。
教学医院，于1996年10月至2003年9月进行。
共有100例连续患者（平均年龄62.1±10.9岁；范围31 - 86岁），患有巴雷特化生中出现的低风险食管腺癌（宏观类型I、IIa、IIb和IIc；病变直径达20毫米；黏膜病变未侵犯淋巴管和静脉；组织学分级为G1和G2）。
采用吸切技术进行内镜切除术。
局部完全缓解。
共进行了144次切除（每位患者1.47次），无技术问题。未发生重大并发症，仅出现11例轻微并发症（血红蛋白下降未超过2 g/dL的出血；采用注射疗法治疗）。100例患者中有99例在1.9个月（范围1 - 18个月）且最多进行3次切除后实现局部完全缓解。在平均36.7个月的随访期内，11%的患者发现复发性或异时性癌，但所有这些病例均可行内镜切除重复治疗。计算得出的5年生存率为98%。2例患者死于其他原因。
非盲法、非随机研究。
内镜切除术对于早期食管腺癌（巴雷特癌）低风险患者具有良好的治疗效果。
