Division of Gastroenterology and Hepatology, Department of Medicine, University of Virginia, Charlottesville, Virginia 22908, USA.
Gastrointest Endosc. 2010 Nov;72(5):1066-71. doi: 10.1016/j.gie.2010.06.008. Epub 2010 Sep 25.
The electrosurgical knives required to perform endoscopic submucosal dissection (ESD) have recently passed the 510(k) premarketing evaluation by the U.S. Food and Drug Administration and are now available for purchase in the United States. Challenges to ESD being more widely performed in the United States include the lack of intensive hands-on training programs and a low incidence of appropriate, highly dysplastic gastric lesions on which an ESD-trained endoscopist can begin performing this procedure in patients. Furthermore, there are no guidelines regarding the safety of continuing antiplatelet therapy in patients undergoing ESD.
To report on the first gastric ESD performed in the United States by using recently approved electrosurgical knives on a patient who was maintained on aspirin therapy.
Case report.
Large academic medical center.
One patient with a 2-cm high-grade dysplasia (HGD) lesion in the posterior antrum who had indwelling coronary stents and was maintained on aspirin therapy throughout the periprocedural period.
High-definition white-light and narrow-band imaging endoscopy, endosonography, and ESD by using recently approved electrosurgical knives.
Complete resection of the HGD gastric lesion.
En bloc complete resection of the HGD gastric lesion was achieved without any immediate or delayed bleeding or perforation. No residual or recurrent dysplasia was found on 1- or 3-month follow-up endoscopies.
Generalizations cannot be made from this single case.
After receiving intensive hands-on training in both ex vivo and in vivo animal models, gastric ESD was successfully performed by 2 U.S. endoscopists by using recently approved electrosurgical knives in a patient maintained on aspirin therapy without any complications.
用于进行内镜黏膜下剥离术（ESD）的电外科器械最近通过了美国食品和药物管理局的 510(k) 上市前评估，现已可在美国购买。在美国更广泛地开展 ESD 面临的挑战包括缺乏强化实践培训计划，以及适合进行 ESD 培训的内镜医生开始在患者中进行此操作的高度异型性胃病变的发生率较低。此外，对于接受 ESD 的患者继续抗血小板治疗的安全性尚无指南。
报告首例在美国使用最近批准的电外科器械进行的胃 ESD，该患者在围手术期一直接受阿司匹林治疗。
病例报告。
大型学术医疗中心。
一名患者的胃窦后壁有 2cm 高级别异型增生（HGD）病变，其体内有留置冠状动脉支架，整个围手术期一直接受阿司匹林治疗。
高清白光和窄带成像内镜检查、内镜超声检查和使用最近批准的电外科器械进行 ESD。
HGD 胃病变的完全切除。
整块切除 HGD 胃病变，无即刻或延迟出血或穿孔。在 1 或 3 个月的随访内镜检查中未发现残留或复发异型增生。
不能从这单个病例推断出普遍性结论。
在接受了大量的离体和活体动物模型的实践培训后，2 名美国内镜医生使用最近批准的电外科器械成功地为接受阿司匹林治疗的患者进行了胃 ESD，无任何并发症。
