Larghi Alberto, Waxman Irving
Digestive Endoscopy Unit, Catholic University, Largo A. Gemelli 8, 00192 Rome, Italy.
Gastrointest Endosc Clin N Am. 2007 Jul;17(3):441-69, v. doi: 10.1016/j.giec.2007.05.012.
Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) provide new alternatives for minimally invasive treatment of superficial gastrointestinal malignancies. Evidence suggests that these techniques can be performed safely and have comparable outcomes to surgery with less morbidity and better quality of life due to their tissue-sparing nature when compared with conventional surgery. Although the techniques and accessories have become standardized, there is room for improvement, and further research and development are required. Current challenges facing American gastroenterologists or endoscopic surgeons include access to training and lack of appropriate reimbursement for these heavy-weighted and technically demanding procedures. Nevertheless, EMR and ESD are here to stay and are only the first steps toward true radical endoluminal resection of GI malignancies.
内镜黏膜切除术（EMR）和内镜黏膜下剥离术（ESD）为浅表性胃肠道恶性肿瘤的微创治疗提供了新的选择。有证据表明，这些技术可以安全实施，与手术相比，由于其保留组织的特性，并发症更少，生活质量更高，结果相当。尽管技术和附件已实现标准化，但仍有改进空间，需要进一步研发。美国胃肠病学家或内镜外科医生目前面临的挑战包括获得培训的机会以及对这些高难度、技术要求高的手术缺乏适当的报销。然而，EMR和ESD将继续存在，并且只是朝着真正彻底的胃肠道恶性肿瘤腔内切除术迈出的第一步。
