aDepartment of Gastroenterology, Digestive Endoscopy Unit, IRCCS Istituto Clinico Humanitas, Milan bDepartment of Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy.
Eur J Gastroenterol Hepatol. 2013 Nov;25(11):1261-4. doi: 10.1097/MEG.0b013e328364b492.
Endoscopic submucosal dissection (ESD) has been found to be effective and safe for endoscopic removal of early gastric neoplasia in large Asian series. However, few data are available on the use of ESD in western countries. We assessed the efficacy of ESD performed in patients with early gastric neoplastic lesions.
We analyzed prospectively collected data of consecutive patients who underwent the ESD procedure for gastric neoplasia at a single Italian center. Procedure-related outcomes, including complete histological resection rate (i.e. R0 resection), immediate and late complication rate, procedure-related mortality, and follow-up were evaluated.
Forty-two patients underwent gastric ESD. The en-bloc removal of lesions was successful in all cases, whereas R0 was achieved in 39 (92.8%) patients. A bleeding episode was observed in three (7.1%) patients, which was successfully managed by endoclip positioning. No perforations and procedure-related deaths were observed. The median follow-up period was 19 months (range: 9-53). A small residue of adenomatous lesion and a recurrent dysplastic lesion were removed by endoscopic mucosal resection in two (5%) patients.
Our data are comparable with those of larger Asian series. Use of ESD for removal of gastric neoplastic lesions should be implemented in western countries.
在亚洲的大型系列研究中，内镜黏膜下剥离术（ESD）已被证明对早期胃肿瘤的内镜切除是有效且安全的。然而，在西方国家，关于 ESD 的使用数据较少。我们评估了 ESD 在治疗胃肿瘤患者中的疗效。
我们对在意大利单一中心接受 ESD 手术治疗胃肿瘤的连续患者的前瞻性收集数据进行了分析。评估了与操作相关的结果，包括完全组织学切除率（即 R0 切除）、即刻和迟发性并发症发生率、与操作相关的死亡率以及随访情况。
42 名患者接受了胃 ESD。所有病例均成功进行了整块切除，而 39 例（92.8%）患者达到了 R0 切除。3 例（7.1%）患者出现出血事件，通过内镜夹定位成功进行了处理。未观察到穿孔和与操作相关的死亡。中位随访时间为 19 个月（范围：9-53）。2 例（5%）患者通过内镜黏膜切除术切除了残留的腺瘤性病变和复发性发育不良病变。
我们的数据与更大的亚洲系列数据相当。ESD 用于胃肿瘤切除应在西方国家实施。
