III Department of Gastroenterology, Klinikum Augsburg, Augsburg, Germany.
Endoscopy. 2010 Dec;42(12):1037-44. doi: 10.1055/s-0030-1255668. Epub 2010 Oct 22.
Endoscopic submucosal dissection (ESD) is a promising technique for the resection of early gastric neoplasia. There are only a few data from the Western world to date.
Over a 7-year-period, 104 gastric lesions were treated with ESD in a European referral center, of which 91 were included in this study. A total of 66 lesions were early gastric cancer (EGC) and 25 were adenomas. Of the EGCs, 11 lesions (16.7 %) fulfilled the guideline criteria (EGC-GC) and 55 lesions (83.3 %) fulfilled the expanded resection criteria (EGC-EC) of the Japanese guidelines for the treatment of gastric cancer.
ESD was technically possible in 85 lesions (93.4 %). In six lesions ESD was not possible due to non-lifting. En bloc resection rates for all lesions, ECGs-GC, ECGs-EC, and adenomas were 87.1 %, 100 %, 88.2 %, and 79.2 %, respectively. R0 en bloc resection rates were 74.1 %, 90 %, 68.6 %, and 79.2 %, respectively. Complications were: one perforation during piecemeal endoscopic mucosal resection of a lesion in which ESD was judged to be impossible (1.2 %); three clinically relevant bleedings (3.5 %); one gastric ischemia (1.2 %); and four strictures (4.7 %). No mortality was observed. There were five recurrences after piecemeal resection (50 %) compared with only one after en bloc resection (1.5 %; P < 0.05). The rate of recurrence for EGCs was 5.6 %, and this were seen exclusively after piecemeal resection.
Our data show that ESD is a feasible technique in Europe even in patients with EGC according to the extended criteria. Resection rates are promising and complication rates are acceptable. Results are worse compared with large studies from Japan but still excellent regarding the learning curve of the method. ESD should be offered as the treatment of choice for early gastric neoplasia especially when en bloc resection cannot be performed with other resection techniques.
内镜黏膜下剥离术（ESD）是一种有前途的技术，可用于切除早期胃癌。迄今为止，来自西方世界的数据很少。
在一个欧洲转诊中心，经过 7 年的时间，用 ESD 治疗了 104 个胃病变，其中 91 个纳入本研究。总共 66 个病变为早期胃癌（EGC），25 个为腺瘤。其中，11 个病变（16.7%）符合指南标准（EGC-GC），55 个病变（83.3%）符合日本胃癌治疗指南的扩大切除标准（EGC-EC）。
ESD 在 85 个病变（93.4%）中是可行的。由于不能抬起，有 6 个病变的 ESD 不可行。所有病变、EGC-GC、EGC-EC 和腺瘤的整块切除率分别为 87.1%、100%、88.2%和 79.2%。R0 整块切除率分别为 74.1%、90%、68.6%和 79.2%。并发症有：1 例因判断 ESD 不可能而进行的病变分片内镜黏膜切除术穿孔（1.2%）；3 例临床相关出血（3.5%）；1 例胃缺血（1.2%）；和 4 例狭窄（4.7%）。无死亡。分片切除后有 5 例（50%）复发，整块切除后仅 1 例（1.5%）复发（P<0.05）。EGC 的复发率为 5.6%，且仅在分片切除后出现。
我们的数据表明，即使在符合扩大标准的 EGC 患者中，ESD 在欧洲也是一种可行的技术。切除率有希望，并发症发生率可接受。与来自日本的大型研究相比结果较差，但考虑到该方法的学习曲线，结果仍然很好。对于早期胃癌，尤其是当其他切除技术不能进行整块切除时，ESD 应作为首选治疗方法。
