Division of Gastroenterology, Department of Internal Medicine, The Catholic University of Korea College of Medicine, #505 Banpo-dong, Seocho-gu, Seoul 137-701, Korea.
Dig Dis Sci. 2012 Jan;57(1):148-54. doi: 10.1007/s10620-011-1863-z. Epub 2011 Aug 13.
Tumors involving the pyloric channel have been considered as difficult lesions for successful endoscopic resection. We studied the feasibility of endoscopic submucosal dissection (ESD) using retroflexion in the duodenum to resect the gastric neoplasia involving the pyloric channel.
To compare the treatment outcomes of a new ESD technique using retroflexion to those without retroflexion in the duodenum.
Twenty-four cases of gastric neoplasia involving the pyloric channel were resected by ESD. In 14 cases, ESDs were performed from both the antrum and duodenal bulb using retroflexion (retroflexion group). In ten cases, ESDs were performed conventionally only from the side of the antrum (conventional group). We compared the outcomes between the two methods.
There was no complication regarding retroflexion in the duodenum. In the retroflexion group, the en bloc and complete resection rate was 100%, respectively. The rate of complete resection was significantly higher in the retroflexion group than in the conventional group (P = 0.01). In the conventional group, three patients with early gastric cancer underwent additional subtotal gastrectomy for positive lateral margin, and one patient with perforation was treated additionally by surgical repair. In the retroflexion group, microperforation and pyloric channel stenosis occurred in one patient, which resolved with conservative treatment.
Tumors involving the pyloric channel could be successfully resected by ESD using retroflexion in the duodenum without severe complication. This technique appears to be a feasible and effective method for the treatment of tumors involving the pyloric channel.
涉及幽门通道的肿瘤被认为是内镜切除成功的困难病变。我们研究了使用十二指肠反转进行内镜黏膜下剥离（ESD）切除涉及幽门通道的胃肿瘤的可行性。
比较使用十二指肠反转的新 ESD 技术与不使用十二指肠反转的治疗效果。
对 24 例涉及幽门通道的胃肿瘤采用 ESD 进行切除。在 14 例中，通过反转从胃窦和十二指肠球部进行 ESD（反转组）。在 10 例中，仅从胃窦侧常规进行 ESD（常规组）。我们比较了两种方法的结果。
十二指肠反转无并发症。在反转组中，整块切除率和完全切除率分别为 100%。反转组的完全切除率明显高于常规组（P=0.01）。在常规组中，3 例早期胃癌患者因侧缘阳性行额外的胃大部切除术，1 例穿孔患者行额外的手术修复。在反转组中，1 例患者发生微小穿孔和幽门通道狭窄，经保守治疗缓解。
通过使用十二指肠反转的 ESD 可以成功切除涉及幽门通道的肿瘤，且无严重并发症。该技术似乎是治疗涉及幽门通道肿瘤的一种可行且有效的方法。
