Hurlstone D P, Shorthouse A J, Brown S R, Tiffin N, Cross S S
Gastroenterology and Liver Unit at the Royal Hallamshire Hospital, Sheffield, UK.
Colorectal Dis. 2008 Nov;10(9):891-7. doi: 10.1111/j.1463-1318.2008.01510.x. Epub 2008 Mar 15.
A prospective technical feasibility study of cap assisted ESD for 'curative intent' in patients with residual or local neoplastic recurrence following EMR. Primary end points were second stage R0 resection rate, safety and recurrence.
Salvage ESD was performed using the Olympus GIF-XQ240 gastroscope and KD-630L insulation tipped knife. Thirty-day mortality, re-admission rates, complications and histological resection status were collected prospectively up to 9 months following index resection.
Thirty patients met eligibility criteria. Index R0 resection was achieved in 25/30 (83%) lesions. One patient underwent surgical excision with a second receiving a curative second stage dissection. Ninety-six per cent (29/30) patients were discharged within 24 h of the procedure with a 0% 30-day mortality and re-admission rate. Bleeding occurred in 5/30 (16%) treated successfully with endoluminal haemostasis. There were no perforations. Overall 'cure' rates at short-term follow-up [median 6/12 (range; 3-18)] was 96%.
This novel application of ESD for first line 'salvage' therapy in treating residual or locally recurrent neoplastic disease may be a safe, minimally invasive and cost effective alternative to direct surgical resection in a select patient cohort.
对内镜下黏膜切除术（EMR）后残留或局部肿瘤复发患者进行帽辅助内镜黏膜下剥离术（ESD）以达到“治愈目的”的前瞻性技术可行性研究。主要终点为二期R0切除率、安全性和复发情况。
使用奥林巴斯GIF-XQ240胃镜和KD-630L绝缘头刀进行挽救性ESD。前瞻性收集直至初次切除后9个月的30天死亡率、再次入院率、并发症及组织学切除情况。
30例患者符合入选标准。25/30（83%）个病变实现了初次R0切除。1例患者接受了手术切除，另1例接受了根治性二期清扫。96%（29/30）的患者在术后24小时内出院，30天死亡率和再次入院率均为0%。5/30（16%）例发生出血，经腔内止血成功治疗。无穿孔发生。短期随访[中位时间6/12（范围：3 - 18）]时的总体“治愈”率为96%。
ESD在治疗残留或局部复发性肿瘤疾病的一线“挽救”治疗中的这种新应用，对于特定患者群体而言，可能是一种安全、微创且具有成本效益的直接手术切除替代方案。
