Division of Gastroenterology, Kocaeli University Medical School, Kocaeli 41000, Turkey.
World J Gastroenterol. 2011 Apr 7;17(13):1701-9. doi: 10.3748/wjg.v17.i13.1701.
To investigate the indication, feasibility, safety, and clinical utility of endoscopic submucosal dissection (ESD) in the management of various gastrointestinal pathologies.
The medical records of 60 consecutive patients (34 female, 26 male) who underwent ESD at the gastroenterology department of Kocaeli University from 2006-2010 were examined. Patients selected for ESD had premalignant lesions or non-invasive early cancers of the gastrointestinal tract and had endoscopic and histological diagnoses. Early cancers were considered to be confined to the submucosa, with no lymph node involvement by means of computed tomography and endosonography.
Sixty ESD procedures were performed. The indications were epithelial lesions (n = 39) (33/39 adenoma with high grade dysplasia, 6/39 adenoma with low grade dysplasia), neuroendocrine tumor (n = 7), cancer (n = 7) (5/7 early colorectal cancer, 2/7 early gastric cancer), granular cell tumor (n = 3), gastrointestinal stromal tumor (n = 2), and leiomyoma (n = 2). En bloc and piecemeal resection rates were 91.6% (55/60) and 8.3% (5/60), respectively. Complete and incomplete resection rates were 96.6% (58/60) and 3.3% (2/60), respectively. Complications were major bleeding [n = 3 (5%)] and perforations [n = 5 (8.3%)] (4 colon, 1 stomach). Two patients with colonic perforations and two patients with submucosal lymphatic and microvasculature invasion (1 gastric carcinoid tumor, 1 colonic adenocarcinoma) were referred to surgery. During a mean follow-up of 12 mo, 1 patient with adenoma with high grade dysplasia underwent a second ESD procedure to resect a local recurrence.
ESD is a feasible and safe method for treatment of premalignant lesions and early malignant gastrointestinal epithelial and subepithelial lesions. Successful en bloc and complete resection of lesions yield high cure rates with low recurrence.
探讨内镜黏膜下剥离术（ESD）在处理各种胃肠道病变中的适应证、可行性、安全性和临床应用价值。
对 2006 年至 2010 年在科贾埃利大学消化内科接受 ESD 的 60 例连续患者（34 例女性，26 例男性）的病历进行了检查。选择接受 ESD 的患者患有胃肠道的癌前病变或非浸润性早期癌，并且具有内镜和组织学诊断。早期癌症被认为局限于黏膜下层，通过计算机断层扫描和内镜超声检查没有淋巴结受累。
共进行了 60 例 ESD 手术。适应证为上皮病变（n=39）（33/39 高级别异型增生腺瘤，6/39 低级别异型增生腺瘤），神经内分泌肿瘤（n=7），癌症（n=7）（5/7 结直肠早期癌，2/7 早期胃癌），颗粒细胞瘤（n=3），胃肠道间质瘤（n=2）和平滑肌瘤（n=2）。整块切除率和分片切除率分别为 91.6%（55/60）和 8.3%（5/60）。完全切除率和不完全切除率分别为 96.6%（58/60）和 3.3%（2/60）。并发症为大出血[n=3（5%）]和穿孔[n=5（8.3%）]（4 例结肠，1 例胃）。2 例结肠穿孔和 2 例黏膜下淋巴管和微血管侵犯（1 例胃类癌，1 例结肠腺癌）的患者转至外科手术。在平均 12 个月的随访期间，1 例高级别异型增生腺瘤患者因局部复发而行第二次 ESD 手术切除。
ESD 是治疗胃肠道上皮和黏膜下癌前病变和早期恶性上皮病变的可行且安全的方法。成功的整块和完全切除病变可获得高治愈率，复发率低。
