Department of Gastroenterology, Shandong University Qilu Hospital, and Shandong University, 107 Wenhuaxi Road, Jinan, 250012, China.
Surg Endosc. 2011 Jun;25(6):1933-8. doi: 10.1007/s00464-010-1490-3. Epub 2010 Dec 7.
Endoscopic mucosal resection (EMR) is an alternative to surgery for removal of superficial gastric neoplastic lesions. Residual neoplastic tissue of the resection interface is difficult to detect by conventional endoscopy. The aim of this study is to assess the efficacy of confocal laser endomicroscopy (CLE) in predicting complete resection margins after EMR.
EMR was performed by using cap-assisted or "inject and cut" resection technique. Two weeks after EMR, the circumferential margins of the defect were inspected by using CLE, and completeness of excision was predicted from the CLE image. Additional EMR was performed if necessary. In vivo CLE diagnosis was validated against final histopathology.
Twenty-seven lesions were removed by EMR in 27 patients. After excluding 3 patients for gastrectomy, a total of 24 patients underwent CLE assessment, of whom 9 with indefinite lateral margins underwent at least two consecutive CLE follow-ups. A total of 19 lesions were regarded as complete remission, and 5 lesions (21.7%) were incompletely excised according to final pathologic diagnosis. Accuracy of CLE in predicting incomplete resection for original lesions was 91.7%, with sensitivity and specificity of 100.0 and 89.5%, respectively. The residual lesions were treated by additional EMR guided by CLE. There was no recurrence on endoscopic biopsies at mean (range) follow-up of 8.3 (4-15) months.
Confocal laser endomicroscopy has high accuracy for prediction of remnant tissue after EMR, and may lead to significant improvements in clinical surveillance after endoscopic resection.
内镜黏膜切除术（EMR）是一种替代手术切除胃浅表性肿瘤病变的方法。常规内镜很难检测到切除界面的残留肿瘤组织。本研究旨在评估共聚焦激光内镜（CLE）在预测 EMR 后切除边缘完全性的疗效。
采用帽辅助或“注射-切割”切除技术进行 EMR。EMR 后 2 周，用 CLE 检查缺损的环周边缘，并根据 CLE 图像预测切除的完整性。如果需要，可进行额外的 EMR。活体 CLE 诊断与最终组织病理学进行对照验证。
27 例患者共切除 27 个病灶。排除 3 例行胃切除术的患者后，共有 24 例患者接受了 CLE 评估，其中 9 例侧向边界不确定的患者至少连续进行了 2 次 CLE 随访。共有 19 个病灶被认为完全缓解，5 个病灶（21.7%）根据最终病理诊断不完全切除。CLE 预测原始病灶不完全切除的准确性为 91.7%，敏感性和特异性分别为 100.0%和 89.5%。残留病灶用 CLE 引导的额外 EMR 治疗。在平均（范围）8.3（4-15）个月的内镜活检随访中，无复发。
共聚焦激光内镜对 EMR 后残留组织的预测具有较高的准确性，可能会显著改善内镜切除后的临床监测。
