Department of Gastroenterology, Saku Central Hospital, Saku, Japan.
J Gastroenterol Hepatol. 2012 Mar;27(3):510-5. doi: 10.1111/j.1440-1746.2011.06926.x.
The change of therapeutic strategy for large colorectal tumors after the introduction of endoscopic submucosal dissection (ESD) has not yet been clarified. The aim of this study was to estimate the impact of ESD as an initial treatment strategy.
A questionnaire was administered to nine expert panelists in colorectal ESD. The questionnaire used retrospective data from consecutive case series. Forty-seven cases of early colorectal tumors (≥ 20 mm) were included. Endoscopic growth types were 25 laterally-spreading tumors (LST) of granular type (G), 15 LST of non-granular types (NG), and seven protruded types. Pathological diagnoses included 15 adenomas (Ad), 18 intramucosal cancers (M), three submucosally-shallow invasive cancers (< 1000 µm) (SMs), and 11 submucosally-deep invasive cancers (≥ 1000 µm) (SMd). The expert panelists completed questionnaires about recommended initial treatment under suppositions of before and after the introduction of ESD. Over-surgery was defined as surgery for Ad, M, and SMs. Non-curative endoscopic resection (ER) was defined as ER for SMd.
After the introduction of ESD, the reduction in the over-surgery rate was estimated at 10.8% for Ad, M, and SMs, and the increase in the non-curative ER rate was estimated at 27.2% for SMd. By endoscopic growth type, the reduction of over-surgery rates for LST-NG, LST-G, and protruded type was 15.5%, 10.5%, and 2.2%, respectively.
The endoscopists changed their therapeutic strategy for large colorectal tumors to reduce over-surgery, especially in LST-NG, demonstrating the impact of ESD.
内镜黏膜下剥离术（ESD）引入后，大肠肿瘤治疗策略的改变尚未阐明。本研究旨在评估 ESD 作为初始治疗策略的影响。
向 9 位大肠 ESD 专家组成员发放问卷。问卷使用连续病例系列的回顾性数据。纳入 47 例早期大肠肿瘤（≥20mm）。内镜下生长类型为 25 例颗粒型侧向扩展肿瘤（LST-G）、15 例非颗粒型 LST（LST-NG）和 7 例隆起型。病理诊断包括 15 例腺瘤（Ad）、18 例黏膜内癌（M）、3 例黏膜浅层浸润癌（<1000μm）（SMs）和 11 例黏膜深层浸润癌（≥1000μm）（SMd）。专家组成员根据 ESD 引入前后的假设完成了关于初始治疗建议的问卷。过度手术定义为 Ad、M 和 SMs 的手术。非治愈性内镜切除（ER）定义为 SMd 的 ER。
ESD 引入后，Ad、M 和 SMs 的过度手术率预计降低 10.8%，SMd 的非治愈性 ER 率预计增加 27.2%。按内镜下生长类型，LST-NG、LST-G 和隆起型的过度手术率降低分别为 15.5%、10.5%和 2.2%。
内镜医师改变了治疗大肠大肿瘤的策略，以减少过度手术，特别是在 LST-NG 中，这表明了 ESD 的影响。
