Tanimoto M A
Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico.
Rev Gastroenterol Mex. 2010;75(2):177-85.
Endoscopic submucosal dissection (ESD) is a novel technique that increases the therapeutic spectrum for early-stage malignant lesions (T1mN0) of gastrointestinal tract.
To review the current training requirements, indications and devices for ESD.
A PubMed search and selection for manuscripts between 2005 and 2009 was performed. Kew words used were of "endoscopic submucosal dissection", "indications", "training" and "devices".
Indications for ESD in early gastrointestinal cancer are: I) Well differentiated and limited to mucosa: a) Non ulcerated: no matters size and shape or, b) Ulcerated: less than 3 cm; II) Poorly-differentiated limited to mucosa: non ulcerated and less than 2 cm; III) Invading submucosa: well differentiated, less than 3 cm with a maximum depth of 500 µm. The most frequently used technique to elevate submucosa is injection of isotonic saline solution with epinephrine and indigo. Technology is evolving with new devices for increasing safety. Training should include at least 30 animal models before attempting to perform the procedure in patients.
ESD is an endoscopic procedure with well established indications that require a special training. Its use in well selected cases is safe and can replace a surgical procedure or other therapeutic modalities.
内镜黏膜下剥离术（ESD）是一种新型技术，可扩大胃肠道早期恶性病变（T1mN0）的治疗范围。
综述ESD目前的培训要求、适应证及设备。
检索并筛选2005年至2009年间PubMed上的文献。使用的关键词为“内镜黏膜下剥离术”“适应证”“培训”及“设备”。
早期胃肠道癌ESD的适应证为：I）高分化且局限于黏膜层：a）无溃疡：无论大小和形状，或b）有溃疡：小于３cm；II）低分化且局限于黏膜层：无溃疡且小于2cm；III）侵犯黏膜下层：高分化，小于3cm，最大深度500μm。最常用的黏膜下层抬举技术是注射含肾上腺素和靛胭脂的等渗盐溶液。随着新设备的出现，技术不断发展以提高安全性。在尝试对患者进行该手术前，培训应至少包括30例动物模型操作。
ESD是一种适应证明确的内镜手术，需要特殊培训。在精心选择的病例中使用ESD是安全的，并且可以替代外科手术或其他治疗方式。
