Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
Dig Endosc. 2012 May;24 Suppl 1:166-71. doi: 10.1111/j.1443-1661.2012.01268.x.
The early diagnosis of early gastrointestinal (GI) diseases is becoming easier than ever before, due to the rapid development of all kinds of endoscopic techniques, including chromoendoscopy, narrowband imaging, magnifying endoscopy, confocal microscopy and autofluorescence imaging. Endoscopic resection is gradually becoming the optimal choice, which is significantly less invasive than conventional surgical interventions. In China, endoscopic resection techniques have been developed very quickly after several pioneers learned from Japanese gastroenterologists. Endoscopic submucosal dissection (ESD) has achieved remarkable initial outcomes, however, large-scale, multicenter, retrospective studies of the long-term follow up of ESD outcomes in China are still lacking. New endoscopic interventions are also being developed from the ESD technique, namely, endoscopic full-thickness resection of gastric submucosal tumors, peroral endoscopic myotomy and submucosal tunneling endoscopic resection techniques. Here, we discuss the current status of endoscopic resection in China and several problems: (i) the lack of guideline or consensus from academic society; (ii) approximately half of the ESD are performed on benign submucosal tumors, so the diagnosis of mucosal cancers needs to be increased; (iii) the standard technique used, results, management of complications and follow-up should be standardized; and (iv) the minimum training requirements, the step-by-step approach should also need to be standardized.
由于各种内镜技术的快速发展，包括色素内镜、窄带成像、放大内镜、共聚焦显微镜和自发荧光成像，早期胃肠道（GI）疾病的早期诊断变得比以往任何时候都更容易。内镜切除逐渐成为最佳选择，其创伤性明显小于传统的手术干预。在中国，几位先驱者向日本胃肠病学家学习后，内镜切除技术发展得非常迅速。内镜黏膜下剥离术（ESD）已取得显著的初步成果，但中国仍缺乏对 ESD 结果的长期随访的大规模、多中心、回顾性研究。还从 ESD 技术发展出新的内镜干预措施，即内镜胃黏膜下固有肌层肿瘤全层切除术、经口内镜肌切开术和黏膜下隧道内镜切除术。在这里，我们讨论中国内镜切除的现状和几个问题：（i）学术学会缺乏指南或共识；（ii）大约一半的 ESD 用于良性黏膜下肿瘤，因此需要增加黏膜癌的诊断；（iii）应标准化使用的标准技术、结果、并发症的处理和随访；以及（iv）还需要标准化最低培训要求和逐步方法。
