Endoscopy Center, Shengjing Hospital, China Medical University, Shenyang 110004, Liaoning Province, China.
Endosc Ultrasound. 2013 Jan;2(1):11-5. doi: 10.7178/eus.04.004.
Esophageal tumors arising in the muscularis propria are difficult to be resected endoscopically using standard electro-surgical techniques, even the endoscopic submucosal dissection (ESD) technique appeared recently. Our purpose is to investigate the efficacy of endoscopic ultrasound (EUS)-assisted tunnel-type ESD for resection of these tumors.
A total of 17 patients were included in this study. A standard endoscope was used. The submucosal tunnel was created with the triangle knife according to the standard ESD technique, about 5 cm proximal to the lesion. EUS was performed within the tunnel to detect the tumor, and then the tumor was separated both from the submucosal and the muscle layers. After the tumor was removed, several clips were used to close the mucosal defect. EUS was performed to evaluate the healing quality 1 week after the procedure.
In all the cases, the tumors were completely resected. Mean tumor size was 24.2 mm (12-50 mm) in diameter. The histo-logical diagnoses were leiomyoma (16/17) and gastrointestinal stromal tumor (GIST, 1/17). Subcutaneous emphysema was found in 2 patients after the procedure, but disappeared by the third day. No patients sustained perforation or developed significant hem-orrhage, and there were no other immediate severe complications after the procedure. The healing quality was satisfying in 16/17 patients evaluated by EUS 1 week after the procedure. No recurrence has been found during follow-up (mean 7 months, range 3-13 months).
EUS-assisted tunnel-type ESD is effective and safe in treatment of esophageal tumors arising in the muscularis pro-pria.
起源于固有肌层的食管肿瘤，即使是最近出现的内镜黏膜下剥离术（ESD）技术，也很难通过标准电外科技术进行内镜切除。我们的目的是研究超声内镜（EUS）辅助隧道式 ESD 切除这些肿瘤的疗效。
本研究共纳入 17 例患者。使用标准内镜。根据标准 ESD 技术，在距病变约 5cm 处的黏膜下隧道内用三角刀创建黏膜下隧道。在隧道内进行 EUS 检查以检测肿瘤，然后将肿瘤与黏膜下层和肌肉层分离。肿瘤切除后，使用多个夹闭器封闭黏膜缺损。术后 1 周行 EUS 评估愈合质量。
所有病例均完整切除肿瘤。肿瘤平均直径为 24.2mm（12-50mm）。组织学诊断为平滑肌瘤（16/17）和胃肠道间质瘤（GIST，1/17）。术后 2 例患者出现皮下气肿，但第 3 天消失。无患者发生穿孔或明显出血，术后无其他严重并发症。17 例患者中有 16 例在术后 1 周 EUS 评估时愈合质量满意。随访期间（平均 7 个月，范围 3-13 个月）未发现复发。
EUS 辅助隧道式 ESD 治疗起源于固有肌层的食管肿瘤是有效且安全的。
