Espinel Jesús, Pinedo Eugenia, Ojeda Vanesa, Del Rio Maria Guerra
Jesús Espinel, Department of Digestive Diseases, Hospital Universitario de León, 24071 León, Spain.
World J Gastrointest Endosc. 2015 Apr 16;7(4):370-80. doi: 10.4253/wjge.v7.i4.370.
Endoscopic resection (ER) is at present an accepted treatment for superficial gastrointestinal neoplasia. ER provides similar efficacy to surgery; however, it is minimally invasive and less expensive. Endoscopic mucosal resection (EMR) is superior to biopsy for diagnosing advanced dysplasia and can change the diagnostic grade and the management. Several EMR techniques have been described that are alternatively used dependent upon the endoscopist personal experience, the anatomic conditions and the endoscopic appearance of the lesion to be resected. The literature suggests that EMR offers comparable outcomes to surgery for selected indications. EMR techniques using a cap fitted endoscope and EMR using a ligation device [multiband mucosectomy (MBM)] are the most frequently use. MBM technique does not require submucosal injection as with the endoscopic resection-cap technique, multiple resections can be performed with the same snare, pre-looping the endoscopic resection-snare in the ridge of the cap is not necessary, MBM does not require withdrawal of the endoscope between resections and up to six consecutive resections can be performed. This reduces the time and cost required for the procedure, while also reducing patient discomfort. Despite the increasing popularity of MBM, data on the safety and efficacy of this technique in upper gastrointestinal lesions with advanced dysplasia, defined as those lesions that have high-grade dysplasia or early cancer, is limited.
内镜切除术（ER）目前是治疗浅表性胃肠道肿瘤的一种公认的方法。ER与手术具有相似的疗效；然而，它具有微创性且成本较低。内镜黏膜切除术（EMR）在诊断高级别异型增生方面优于活检，并且可以改变诊断分级和治疗方式。已经描述了几种EMR技术，可根据内镜医师的个人经验、解剖条件和待切除病变的内镜表现交替使用。文献表明，对于某些适应症，EMR与手术的疗效相当。使用带帽内镜的EMR技术和使用结扎装置的EMR[多环黏膜切除术（MBM）]是最常用的。与内镜切除术-帽技术不同，MBM技术不需要黏膜下注射，可以使用同一圈套器进行多次切除，无需在内镜切除圈套器的帽缘预套圈，MBM在切除之间不需要拔出内镜，最多可连续进行六次切除。这减少了手术所需的时间和成本，同时也减轻了患者的不适。尽管MBM越来越受欢迎，但关于该技术在高级别异型增生（定义为具有高级别异型增生或早期癌症的病变）的上消化道病变中的安全性和有效性的数据有限。
