Shinozaki Satoshi, Hayashi Yoshikazu, Lefor Alan Kawarai, Yamamoto Hironori
Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan.
Shinozaki Medical Clinic, Tochigi, Japan.
Dig Endosc. 2016 Apr;28(3):289-95. doi: 10.1111/den.12566. Epub 2015 Dec 9.
Development and improvement of endoscopic techniques and devices have changed the treatment of colorectal tumors over the last decade. For the treatment of diminutive polyps, the cold snare technique of the West is becoming a promising treatment in the East because of its short procedure time and low rate of delayed bleeding by eliminating the delayed effect of electrocautery. Rather than using piecemeal endoscopic mucosal resection or surgical resection for the treatment of large superficial tumors, the technique of the East of endoscopic submucosal dissection (ESD) achieves a high success rate of en bloc R0 resection, enabling detailed pathological evaluation with less invasive treatment. This procedure should also be useful in the West where large colorectal tumors are more frequent than in the East. Regarding outcomes, however, in the literature, the definition of 'curative resection' remains somewhat inconsistent and long-term outcomes of patients with deep submucosal and/or lymphovascular invasion in the en bloc specimen have not yet been determined. Large prospective, as well as retrospective, studies of these patients are warranted. When colorectal ESD is difficult because of size or location, the pocket-creation method and/or double-balloon-assisted technique may be useful. In the East, high-quality magnified chromoendoscopy is widely available, and endoscopists try to identify focal submucosal invasion. In the West, a systematic evaluation of surveillance for the prevention of colorectal cancer has been done and is highly refined. The East and West have much to learn from each other.
在过去十年中，内镜技术和设备的发展与改进改变了结直肠肿瘤的治疗方式。对于微小息肉的治疗，西方的冷圈套技术因其操作时间短且通过消除电灼的延迟效应而使延迟出血率低，在东方正成为一种有前景的治疗方法。对于大型浅表肿瘤的治疗，东方的内镜黏膜下剥离术（ESD）技术而非采用内镜下分片黏膜切除术或手术切除，实现了整块R0切除的高成功率，能够在侵入性较小的治疗下进行详细的病理评估。该手术在西方也应有用，因为西方的大型结直肠肿瘤比东方更常见。然而，关于治疗结果，在文献中，“根治性切除”的定义仍有些不一致，并且整块标本中存在深层黏膜下和/或淋巴管侵犯的患者的长期结果尚未确定。有必要对这些患者进行大型前瞻性以及回顾性研究。当由于大小或位置原因结直肠ESD困难时，造袋法和/或双气囊辅助技术可能有用。在东方，高质量的放大染色内镜广泛可用，内镜医师试图识别局灶性黏膜下侵犯。在西方，已经对结直肠癌预防监测进行了系统评估且高度完善。东西方有很多可以相互学习的地方。
