Zhang Yue-Ming, Boerwinkel David F, Qin Xiumin, He Shun, Xue Liyan, Weusten Bas L A M, Dawsey Sanford M, Fleischer David E, Dou Li-Zhou, Liu Yong, Lu Ning, Bergman Jacques J G H M, Wang Gui-Qi
Department of Endoscopy, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, The Netherlands.
Endoscopy. 2016 Apr;48(4):330-8. doi: 10.1055/s-0034-1393358. Epub 2015 Nov 6.
Piecemeal endoscopic resection for esophageal high grade intraepithelial neoplasia (HGIN) or early squamous cell carcinoma (ESCC) is usually performed by cap-assisted endoscopic resection. This requires submucosal lifting and multiple snares. Multiband mucosectomy (MBM) uses a modified variceal band ligator without submucosal lifting. In high-risk areas where ESCC is common and endoscopic expertise is limited, MBM may be a better technique. We aimed to compare MBM to the cap-assisted technique for piecemeal endoscopic resection of esophageal ESCCs.
Patients with mucosal HGIN/ESCC (2 - 6 cm, maximum two-thirds of esophageal circumference) were included. Lesions, delineated by 1.25 % Lugol staining, were randomized to MBM or cap-assisted piecemeal resection. Endpoints were procedure time and costs, complete endoscopic resection, adverse events, and absence of HGIN/ESCC at 3-month and 12-month follow-up.
Endoscopic resection was performed in 84 patients (59 men, mean age 60) using MBM (n = 42) or the endoscopic resection cap (n = 42). There were no differences in baseline characteristics. Endoscopic complete resection was achieved in all lesions. Procedure time was significantly shorter with MBM (11 vs. 22 minutes, P < 0.0001). One perforation, seen after using the endoscopic resection cap, was treated conservatively. Total costs of disposables were lower for MBM (€200 vs. €251, P = 0.04). At 3-month and 12-month follow-ups none of the patients had HGIN/ESCC at the resection site.
Piecemeal endoscopic resection of esophageal ESCC with MBM is faster and cheaper than with the endoscopic resection cap. Both techniques are highly effective and safe. MBM may have significant advantages over the endoscopic resection cap technique, especially in countries where ESCC is extremely common but limited endoscopic expertise and resources exist. (Netherlands trial register: NTR 3246.).
食管高级别上皮内瘤变（HGIN）或早期鳞状细胞癌（ESCC）的内镜分片切除术通常采用帽辅助内镜切除术。这需要进行黏膜下抬举并使用多个圈套器。多环黏膜切除术（MBM）使用改良的静脉曲张套扎器，无需黏膜下抬举。在ESCC常见且内镜专业知识有限的高风险地区，MBM可能是一种更好的技术。我们旨在比较MBM与帽辅助技术用于食管ESCC的内镜分片切除术。
纳入患有黏膜HGIN/ESCC（病变长度2 - 6厘米，最大累及食管周长的三分之二）的患者。通过1.25%卢戈氏碘液染色勾勒出病变，将其随机分为MBM组或帽辅助分片切除术组。观察指标包括手术时间、费用、内镜下完全切除情况、不良事件以及3个月和12个月随访时切除部位无HGIN/ESCC。
84例患者（59例男性，平均年龄60岁）接受了内镜切除术，其中42例采用MBM，42例采用内镜切除帽。两组患者的基线特征无差异。所有病变均实现了内镜下完全切除。MBM的手术时间明显更短（11分钟对22分钟，P < 0.0001）。使用内镜切除帽后出现1例穿孔，经保守治疗。MBM的一次性耗材总成本更低（200欧元对251欧元，P = 0.04）。在3个月和12个月随访时，所有患者的切除部位均无HGIN/ESCC。
与内镜切除帽相比，采用MBM进行食管ESCC的内镜分片切除术更快且更便宜。两种技术都非常有效且安全。MBM可能比内镜切除帽技术具有显著优势，特别是在ESCC极为常见但内镜专业知识和资源有限的国家。（荷兰试验注册编号：NTR 3246）
