Gastrocentro, Digestive Endoscopy Unit, Campinas State University, Campinas, SP, Brazil.
Clinics (Sao Paulo). 2013;68(2):141-6. doi: 10.6061/clinics/2013(02)oa04.
Endoscopic submucosal dissection is a technique developed in Japan for en bloc resection with a lower rate of recurrence. It is considered technically difficult and performed only in specialized centers. This study sought to report the initial experience from the Gastrocentro--Campinas State University for the treatment of gastric and colorectal lesions by endoscopic submucosal dissection.
The guidelines of the Japanese Association of Gastric Cancer were used as evaluative criteria. For colorectal lesions, the recommended standards proposed by Uraoka et al. and Saito et al. were employed. The practicability of the method, the development of complications and histological analysis of the specimens were evaluated.
Sixteen patients underwent endoscopic submucosal dissection from June 2010 to April 2011; nine patients were treated for gastric lesions, and seven were treated for colorectal lesions. The average diameter of the gastric lesions was 28.6 mm, and the duration of resection was 103 min without complications. All lesions presented lesion-free margins. Of the seven colorectal tumors, four were located in the rectum and three were located in the colon. The average size was 26 mm, and the average procedure time was 163 min. Two complications occurred during the rectal resection procedures: perforation, which was treated with an endoscopic clip, and controlled bleeding. One of the lesions presented a compromised lateral margin without relapse after 90 days. Depth margins were all free of lesions.
Endoscopic submucosal dissection at our institution achieved high success rates, with few complications in preliminary procedures. The procedure also made appropriate lesion staging possible.
内镜黏膜下剥离术是日本发展起来的一种整块切除技术，其复发率较低。该技术被认为具有较高的技术难度，仅在专业中心开展。本研究旨在报告 Gastrocentro--Campinas 州立大学内镜黏膜下剥离术治疗胃和结直肠病变的初步经验。
采用日本胃癌协会的评估标准作为评估标准。对于结直肠病变，采用 Uraoka 等人和 Saito 等人提出的推荐标准。评估方法的实用性、并发症的发生情况以及标本的组织学分析。
2010 年 6 月至 2011 年 4 月期间，16 名患者接受了内镜黏膜下剥离术；9 名患者接受了胃病变治疗，7 名患者接受了结直肠病变治疗。胃病变的平均直径为 28.6mm，切除时间为 103 分钟，无并发症。所有病变均有无病变的切缘。7 例结直肠肿瘤中，4 例位于直肠，3 例位于结肠。平均大小为 26mm，平均手术时间为 163 分钟。直肠切除过程中发生了 2 例并发症：穿孔，用内镜夹处理；以及控制出血。其中一个病变的侧缘边界受累，但 90 天后无复发。深度边缘均无病变。
本机构的内镜黏膜下剥离术成功率较高，初步手术并发症较少。该操作还可以进行适当的病变分期。
