Sattianayagam Prayman T, Desmond Paul V, Jayasekera Chatura, Chen Robert Y
Department of Gastroenterology, East Kent Hospitals University Foundation Trust, UK (Prayman T. Sattianayagam) ; Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Australia (Prayman T. Sattianayagam, Paul V. Desmond, Chatura Jayasekera, Robert Y. Chen).
Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Australia (Prayman T. Sattianayagam, Paul V. Desmond, Chatura Jayasekera, Robert Y. Chen).
Ann Gastroenterol. 2014;27(3):212-218.
Endoscopic submucosal dissection (ESD) is a technique for resection of superficial tumors of the gastrointestinal tract. In contrast to Japan and other Asian countries, few data are available in Western countries. The objective of the current study was to evaluate the experience of ESD in a single Australian tertiary center.
The patient features, outcomes and complications of ESD of 20 lesions in 18 patients at a single center between 2008 and 2012, were evaluated retrospectively.
Twenty lesions, in 18 patients of median age 69.5 years, were resected with ESD. Ten patients had gastric lesions (of whom two had two synchronous lesions), four patients had rectal lesions, one had a colonic lesion, one had a duodenal lesion and two had esophageal lesions. The median (range) lesion size was 2.5 (0.5-6.5) cm. In the entire cohort, resection occurred in 80% cases and complete histological resection was achieved in 60% cases. Significant bleeding requiring repeat endoscopy and transfusion occurred in two cases and microscopic perforation occurred in 1 case. Surgery for unsuccessful ESD was pursued without complication in 6 cases. There were two recurrences during follow up of median 36 months, both of which occurred in cases of gastric ESD and one of which (carcinoid) occurred after surgery.
ESD appears feasible in an Australian population. It should however be contemplated in carefully selected patients whilst there is refinement of pre-treatment diagnosis, the ESD technique and the management of its complications.
内镜黏膜下剥离术（ESD）是一种用于切除胃肠道浅表肿瘤的技术。与日本和其他亚洲国家相比，西方国家关于该技术的数据较少。本研究的目的是评估澳大利亚一家三级中心开展ESD的经验。
回顾性评估2008年至2012年期间在一家中心对18例患者的20个病变进行ESD治疗的患者特征、治疗结果及并发症情况。
对18例中位年龄为69.5岁的患者的20个病变进行了ESD切除。10例患者有胃部病变（其中2例有两个同步病变），4例有直肠病变，1例有结肠病变，1例有十二指肠病变，2例有食管病变。病变大小的中位数（范围）为2.5（0.5 - 6.5）cm。在整个队列中，80%的病例实现了切除，60%的病例实现了完整的组织学切除。2例患者发生了需要重复内镜检查和输血的严重出血，1例发生了微小穿孔。6例ESD治疗失败的患者接受了手术治疗，未出现并发症。在中位随访36个月期间有2例复发，均发生在胃部ESD病例中，其中1例（类癌）复发发生在手术后。
ESD在澳大利亚人群中似乎是可行的。然而，在对患者进行仔细筛选的同时，还需要完善治疗前诊断、ESD技术及其并发症的管理。
