Tamegai Y, Saito Y, Masaki N, Hinohara C, Oshima T, Kogure E, Liu Y, Uemura N, Saito K
Department of Gastroenterology, International Medical Center of Japan, Tokyo, Japan.
Endoscopy. 2007 May;39(5):418-22. doi: 10.1055/s-2007-966427.
Endoscopic submucosal dissection (ESD) aims to resect large neoplastic lesions en bloc, allowing for more precise histopathological analysis. The present retrospective study aimed to analyze the technical and clinical outcomes after ESD of colorectal tumors.
ESD was performed for the treatment of 71 colorectal neoplasms in 70 patients (38 men, 32 women; mean age 63.4 years). Lesion size, procedure time, complications, and immediate and follow-up outcomes were evaluated. The results for these 71 lesions were compared with those for a group of 32 lesions treated by conventional piecemeal endoscopic mucosal resection (EMR) performed during the same period.
For the ESD-treated group of lesions, the average lesion size was 32.7 mm (range 13-80 mm), and the mean operating time was 61.1 minutes (range 7-164 minutes). One perforation occurred in the ESD group (1.4%) and this was treated conservatively with clipping. The majority of these lesions (n = 50) were laterally spreading tumors. Histological examination showed low-grade adenoma in 12 cases; high-grade intraepithelial neoplasia in 47 cases; and submucosally invasive cancer in 11 cases, of which four were sm1, and seven were sm2 or sm3 (these seven patients underwent surgery). The en bloc resection rate was 98.6%. For the 64 tumors that were treated by radical endoscopic resection, no tumor recurrence was found after a mean follow-up period of 12.2 months (range 3-34 months) and a mean of 2.1 follow-up endoscopies (range 1-4). This contrasted with the 6.3% recurrence rate in the 32 piecemeal EMR cases (mean tumor size 28.7 mm, range 20-60 mm).
In our hands, ESD is a safe and effective resection technique for large colorectal neoplasms. As experience with the technique increases, it might gradually replace piecemeal EMR in the majority of cases.
内镜黏膜下剥离术（ESD）旨在完整切除大的肿瘤性病变，以便进行更精确的组织病理学分析。本回顾性研究旨在分析结直肠肿瘤ESD术后的技术及临床效果。
对70例患者（38例男性，32例女性；平均年龄63.4岁）的71个结直肠肿瘤进行ESD治疗。评估病变大小、手术时间、并发症以及即刻和随访结果。将这71个病变的结果与同期接受传统内镜黏膜分片切除术（EMR）治疗的32个病变的结果进行比较。
ESD治疗组病变的平均大小为32.7毫米（范围13 - 80毫米），平均手术时间为61.1分钟（范围7 - 164分钟）。ESD组发生1例穿孔（1.4%），通过钛夹保守治疗。这些病变大多数（n = 50）为侧向扩散肿瘤。组织学检查显示12例为低级别腺瘤；47例为高级别上皮内瘤变；11例为黏膜下浸润癌，其中4例为sm1，7例为sm2或sm3（这7例患者接受了手术）。完整切除率为98.6%。对于64个接受根治性内镜切除的肿瘤，平均随访12.2个月（范围3 - 34个月），平均进行2.1次随访内镜检查（范围1 - 4）后未发现肿瘤复发。这与32例EMR分片切除病例6.3%的复发率形成对比（肿瘤平均大小28.7毫米，范围20 - 60毫米）。
在我们的操作中，ESD是一种治疗大的结直肠肿瘤安全有效的切除技术。随着该技术经验的增加，在大多数情况下它可能会逐渐取代EMR分片切除。
