Sato Yuichi, Takeuchi Manabu, Hashimoto Satoru, Mizuno Ken-ichi, Kobayashi Masaaki, Iwafuchi Mitsuya, Narisawa Rintaro, Aoyagi Yutaka
Hepatogastroenterology. 2013 Sep;60(126):1524-9. doi: 10.5754/hge121185.
BACKGROUND/AIMS: Gastric carcinoid tumors (GCTs) often extends into the submucosa, and are therefore difficult to resect completely by using conventional endoscopic mucosal resection (EMR). Endoscopic submucosal dissection (ESD) allows en bloc resection of submucosal gastrointestinal lesions. Therefore, ESD may be a feasible method for complete resection of GCT. Our purpose is to clarify the usefulness of ESD for treatment of type I GCT.
Between 1998 and 2011, EMR or ESD was performed for 13 lesions in 12 patients with type I GCTs. Among the 13 GCTs, 6 were resected using EMR, and 7 were removed using ESD.
All lesions were histologically classified as Grade 1. The depth of invasion was the mucosa for 1 lesion and the submucosa for 12 lesions. The horizontal margins of excision were negative for all lesions; however, the vertical margins were positive in 4 lesions (66.7%) in the EMR group and no lesions (0%) in the ESD group.
The results of this study suggest that ESD for small type I GCT is better to achieve complete resection than conventional EMR. ESD would be an effective technique for the treatment of small type I GCT.
背景/目的：胃类癌肿瘤（GCTs）常浸润至黏膜下层，因此难以通过传统内镜黏膜切除术（EMR）完全切除。内镜黏膜下剥离术（ESD）可完整切除胃肠道黏膜下病变。因此，ESD可能是完全切除GCT的一种可行方法。我们的目的是阐明ESD治疗I型GCT的有效性。
1998年至2011年期间，对12例I型GCT患者的13个病灶进行了EMR或ESD治疗。在这13个GCT中，6个采用EMR切除，7个采用ESD切除。
所有病灶组织学分级均为1级。浸润深度为1个病灶局限于黏膜层，12个病灶浸润至黏膜下层。所有病灶切除的水平切缘均为阴性；然而，EMR组4个病灶（66.7%）的垂直切缘为阳性，ESD组无病灶（0%）垂直切缘阳性。
本研究结果表明，对于小型I型GCT，ESD比传统EMR更能实现完全切除。ESD将是治疗小型I型GCT的有效技术。
