Saito Yutaka, Uraoka Toshio, Matsuda Takahisa, Emura Fabian, Ikehara Hisatomo, Mashimo Yumi, Kikuchi Tsuyoshi, Fu Kuang-I, Sano Yasushi, Saito Daizo
Division of Endoscopy, National Cancer Center Hospital, Tokyo, Japan.
Gastrointest Endosc. 2007 Nov;66(5):966-73. doi: 10.1016/j.gie.2007.02.053. Epub 2007 May 24.
Endoscopic submucosal dissection (ESD) is accepted as a minimally invasive treatment for early gastric cancer; however, it is not widely used in the colorectum because of its technical difficulty.
To determine the feasibility of using ESD for treating large superficial colorectal tumors and to evaluate the clinical outcome.
Case series conducted at the National Cancer Center Hospital in Tokyo.
A total of 198 consecutive patients were treated for 200 lesions.
Procedures were performed, before July 2004, by using a monopolar needle knife or an insulation-tipped knife (IT knife). After July 2004, the procedures were performed by using a bipolar needle knife or an IT knife. After injection of glycerol and sodium hyaluronate acid into the submucosal (sm) layer, a circumferential incision was made and sm dissection was performed endoscopically.
The en bloc resection rate was 84% and the curative resection rate was 83%.
Among the 200 ESDs, 51 involved tubular adenomas, 99 intramucosal cancers, 22 minute sm cancers, and 28 sm deep cancers. The median operation time was 90 minutes, and the mean size of resected specimens was 38 mm (range, 20-150 mm). Perforations occurred in 10 cases (5%) and postoperative bleeding in 4 cases (2%), but only 1 perforation case needed emergency surgery, because endoscopic clipping was ineffective.
No long-term outcome data yet.
ESD is a feasible technique for treating large superficial colorectal tumors, because it provides a higher en bloc resection rate and is less invasive than surgical resection.
内镜黏膜下剥离术（ESD）被公认为是早期胃癌的微创治疗方法；然而，由于技术难度大，它在结直肠癌中的应用并不广泛。
确定ESD治疗大肠大型浅表肿瘤的可行性并评估临床结果。
在东京国立癌症中心医院进行的病例系列研究。
共有198例连续患者接受了200处病变的治疗。
2004年7月之前，使用单极针刀或绝缘头刀（IT刀）进行手术。2004年7月之后，使用双极针刀或IT刀进行手术。在向黏膜下层（sm）注射甘油和透明质酸钠后，进行环形切口并在内镜下进行sm剥离。
整块切除率为84%，根治性切除率为83%。
在200例ESD中，51例为管状腺瘤，99例为黏膜内癌，22例为微小sm癌，28例为sm深层癌。中位手术时间为90分钟，切除标本的平均大小为38mm（范围20 - 150mm）。穿孔发生10例（5%），术后出血4例（2%），但只有1例穿孔病例需要急诊手术，因为内镜夹闭无效。
尚无长期结果数据。
ESD是治疗大肠大型浅表肿瘤的可行技术，因为它能提供更高的整块切除率，且比手术切除的侵入性小。
