Espinel J, Pinedo E, Rascarachi G
Department of Gastroenterology, Hospital de León, Spain.
Rev Esp Enferm Dig. 2009 Jun;101(6):403-7. doi: 10.4321/s1130-01082009000600005.
Due to surgery s high mortality and morbidity, local therapeutic techniques are required for Barrett s high-grade dysplasia (BHGD) and early gastric cancer (EGC). Various techniques are available for endoscopic mucosal resection (EMR) in the GI tract. The " suck and cut technique, which uses a transparent cap or modified multiband variceal ligator, is usually the most practiced method. A multiband ligator (ML) allows sequential resection without the need for submucosal injection and endoscope withdrawal. The objective of this study was to evaluate the efficacy and safety of EMR with a ML device in the treatment of Barrett s high-grade dysplasia and early gastric cancer.
Prospective study. Eight consecutive patients (4 men; median age, 62 years; range 38-89 years) with BHGD (4) or EGC (4) were treated. EMR was performed with a multiband ligator in order to create a pseudopolyp and then permit snare polypectomy of flat mucosal lesions. The pseudopolyp was resected by using pure coagulating current. No submucosal saline injection was administered before resection.
A total of 8 consecutive patients were treated with the multiband ligator (ML) technique. Barrett s esophagus (BE): one patient with long BE received 3 EMR sessions. Three patients presented with short BE and received 1 EMR session each. The histology of the EMR specimens confirmed a moderately differentiated adenocarcinoma with submucosal infiltration (1 patient) and BHGD (3 patients). Early gastric cancer (EGC): 3 patients had EGC (type IIa) and 1 patient had high-grade dysplasia. EMR was accomplished in 1 session for each patient. The histology of EMR specimens confirmed a mucinous adenocarcinoma with submucosal infiltration (1 patient), EGC (2 patients), and HGD (1 patient). Complications (mild esophageal stenosis, minor bleeding) occurred in 2 patients.
EMR has diagnostic and therapeutic implications, and represents a superior diagnostic modality as compared to traditional biopsy. By means of EMR the resected mucosa is pathologically examined, and the lesion may be appropriately treated. EMR-ML is a safe and effective technique for the treatment of superficial lesions of the digestive tract, and is accepted as an alternative to surgical therapy for non-invasive lesions. Long-term follow-up is needed to determine the clinical impact of this method.
由于手术具有较高的死亡率和发病率，巴雷特高度异型增生（BHGD）和早期胃癌（EGC）需要局部治疗技术。胃肠道内镜黏膜切除术（EMR）有多种技术可用。“吸切技术”，即使用透明帽或改良型多环套扎器，通常是最常用的方法。多环套扎器（ML）可进行连续切除，无需黏膜下注射和退出内镜。本研究的目的是评估使用ML装置进行EMR治疗巴雷特高度异型增生和早期胃癌的疗效及安全性。
前瞻性研究。连续8例患者（4例男性；中位年龄62岁；范围38 - 89岁）接受治疗，其中4例为BHGD，4例为EGC。使用多环套扎器进行EMR，以形成假息肉，然后对扁平黏膜病变进行圈套息肉切除术。使用纯凝固电流切除假息肉。切除前未进行黏膜下盐水注射。
总共8例连续患者接受了多环套扎器（ML）技术治疗。巴雷特食管（BE）：1例长段BE患者接受了3次EMR治疗。3例短段BE患者各接受了1次EMR治疗。EMR标本的组织学检查证实为1例伴有黏膜下浸润的中分化腺癌和3例BHGD。早期胃癌（EGC）：3例患者为EGC（IIa型），1例为高度异型增生。每位患者均在1次治疗中完成EMR。EMR标本的组织学检查证实为1例伴有黏膜下浸润的黏液腺癌、2例EGC和1例HGD。2例患者出现并发症（轻度食管狭窄、少量出血）。
EMR具有诊断和治疗意义，与传统活检相比是一种更优的诊断方式。通过EMR可对切除的黏膜进行病理检查，并对病变进行适当治疗。EMR - ML是治疗消化道浅表病变的一种安全有效的技术，被认为是无创病变手术治疗的替代方法。需要长期随访以确定该方法的临床影响。
