Department of Gastroenterology, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan.
Surg Endosc. 2012 Mar;26(3):759-63. doi: 10.1007/s00464-011-1948-y. Epub 2011 Oct 13.
Gastrointestinal (GI) carcinoid tumors less than 10 mm in diameter and limited to the submucosal layer demonstrate a low frequency of lymph node and distant metastasis; endoscopic submucosal dissection (ESD) has been used to treat these tumors. However, the number of reported sample cases of rectal carcinoid tumors treated with ESD remains insufficient, and the safety and efficacy of ESD for gastric and duodenal carcinoid tumors have not been elucidated to date.
From January 2004 to March 2011, a series of 42 gastrointestinal carcinoid tumors (37 rectal, 2 gastric, and 3 duodenal) in 41 consecutive patients were treated with ESD. Therapeutic efficacy, complications, and follow-up results were retrospectively evaluated.
Sessile type (type Is) was the most prevalent lesion. Mean procedural time was 41 ± 20 min. The mean sizes of tumors and resected specimens were 5 ± 3 mm and 19 ± 7, respectively. The overall rate of en bloc resection was 100% (42/42). Postoperative bleeding occurred in two rectal cases (5%), which were successfully managed with endoscopic clipping. Perforation occurred in two duodenal cases, which could be conservatively managed with medical treatment after endoscopic clipping, and neither laparoscopy nor emergent surgery was needed. No recurrence was observed during the mean follow-up period of 37 months.
ESD was a safe and effective endoscopic treatment for rectal and gastric carcinoid tumors, although other treatment modalities were desirable for duodenal carcinoid tumors.
直径小于 10 毫米且局限于黏膜下层的胃肠道（GI）类癌肿瘤淋巴结和远处转移的发生率较低；内镜黏膜下剥离术（ESD）已被用于治疗这些肿瘤。然而，报道的直肠类癌瘤采用 ESD 治疗的样本病例数量仍然不足，并且 ESD 治疗胃和十二指肠类癌瘤的安全性和疗效迄今尚未阐明。
2004 年 1 月至 2011 年 3 月，41 例连续患者中的 42 例胃肠道类癌瘤（37 例直肠、2 例胃和 3 例十二指肠）采用 ESD 治疗。回顾性评估治疗效果、并发症和随访结果。
无蒂型（I 型）是最常见的病变类型。平均手术时间为 41 ± 20 分钟。肿瘤和切除标本的平均大小分别为 5 ± 3 毫米和 19 ± 7 毫米。整块切除率为 100%（42/42）。2 例直肠病例（5%）发生术后出血，经内镜夹闭成功治疗。2 例十二指肠穿孔，内镜夹闭后经药物治疗可保守治疗，无需腹腔镜或急诊手术。在平均 37 个月的随访期间未观察到复发。
ESD 是直肠和胃类癌瘤的一种安全有效的内镜治疗方法，尽管十二指肠类癌瘤需要其他治疗方法。
