Department of Gastroenterology, General Hospital, Sanremo, Italy.
Department of Gastroenterology, Durham Veterans Affairs Medical Center and Duke Medical Center, NC, USA.
Clin Res Hepatol Gastroenterol. 2014 Feb;38(1):81-91. doi: 10.1016/j.clinre.2013.05.015. Epub 2013 Jul 12.
Focal endoscopic mucosal resection (EMR) of visible intraepithelial lesions arising within Barrett's esophagus (BE) may miss synchronous lesions that are not endoscopically apparent. Stepwise radical endoscopic resection would obviate this concern by removing all BE; however, it requires repeated endoscopy which may increase the risk of complications, particularly for patients with circumferential BE. The aim of the study was to evaluate the safety and efficacy of one-step complete circumferential resection of BE by cap-assisted EMR (EMR-C) among patients with circumferential BE and high-grade dysplasia or intramucosal carcinoma.
Between January 2003 and March 2010, 47 patients with circumferential BE and biopsy-proven high-grade dysplasia or intramucosal cancer underwent EMR-C. We evaluated: (1) complete eradication of neoplasia, (2) complete eradication of metaplasia, and (3) complications including bleeding and esophageal stricture.
Complete eradication of neoplasia and complete eradication of metaplasia were achieved after a median follow-up of 18.4 months in 91% (43/47) of patients. After EMR-C, two patients (one IMC, one invasive cancer) underwent esophagectomy. Histology of the resected specimens showed no residual disease and a T1bN0 lesion, respectively. Two patients had progression of neoplasia. A stenosis occurred in 18 out of 45 patients (40%). All stenoses were treated with dilations and two required temporary placement of a covered stent.
One-step complete EMR-C is a safe and effective technique which can be considered in patients with early neoplastic lesions. Although 40% of patients developed dysphagia, this could well be managed endoscopically.
内镜下黏膜切除术（EMR）可切除 Barrett 食管（BE）中可见的上皮内病变，但可能会遗漏肉眼不可见的同步病变。逐步根治性内镜切除术通过切除所有 BE 来消除这种担忧；然而，它需要重复进行内镜检查，这可能会增加并发症的风险，尤其是对于环形 BE 的患者。本研究旨在评估套扎辅助 EMR（EMR-C）在环形 BE 伴高级别异型增生或黏膜内癌患者中的安全性和有效性。
2003 年 1 月至 2010 年 3 月，47 例环形 BE 伴活检证实的高级别异型增生或黏膜内癌患者接受了 EMR-C。我们评估了：（1）肿瘤的完全消除；（2）化生的完全消除；（3）包括出血和食管狭窄在内的并发症。
在 91%（43/47）的患者中位随访 18.4 个月后，肿瘤和化生的完全消除率分别为 91%（43/47）和 87%（41/47）。EMR-C 后，2 例（1 例 IMC，1 例浸润性癌）患者接受了食管切除术。切除标本的组织学检查显示无残留疾病和 T1bN0 病变。2 例患者出现肿瘤进展。45 例患者中有 18 例（40%）发生狭窄。所有狭窄均经扩张治疗，2 例需要临时放置覆盖支架。
一步法完全 EMR-C 是一种安全有效的技术，可用于治疗早期肿瘤性病变患者。尽管 40%的患者出现吞咽困难，但这种情况可以通过内镜治疗很好地处理。
