Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom.
Department of Gastroenterology, Endoscopy Division, Humanitas Research Hospital, Milan, Italy.
Gastrointest Endosc. 2017 Oct;86(4):608-618. doi: 10.1016/j.gie.2017.01.027. Epub 2017 Jan 31.
Endoscopic submucosal dissection (ESD) is an effective technique to resect early Barrett's neoplasia and has advantages over conventional EMR in that it enables en-bloc resection and accurate histopathologic analysis of cancer resection margins. However, its long learning curve and higher adverse event rate have tempered its uptake in the West. We aimed to analyze the safety and efficacy of ESD when used to resect complex Barrett's neoplasia. The primary endpoint was the en-bloc and R0 resection rate.
This was a retrospective analysis of 143 ESDs for Barrett's neoplasia performed in 3 tertiary referral centers from 2008 to 2016.
The mean lesion size was 31.1 mm (range, 5-90) and median follow-up time 21.6 months (interquartile range, 11.0-32.6). In total, 24.5% of lesions (35/143) were scarred after previous endoscopic resection, surgery, or radiotherapy. The en-bloc resection rate was 90.8% and R0 resection rate 79% in this series. The overall adverse event rate was 3.5% (1.4% bleeding, 0% perforation, and 2.1% stricture formation). The expanded curative resection rate was 65.8%, reflecting the R0 resection rate and proportion of cases with more advanced disease. Submucosal cancer was identified as a significant factor affecting the R0 resection rate.
We demonstrated the feasibility and safety of ESD in the West for resection of complex Barrett's neoplasia including large, nodular, or scarred lesions. This is a safe and effective technique with a low adverse event rate when performed by an experienced operator. The en-bloc resection rate reached a plateau once 30 procedures had been performed.
内镜黏膜下剥离术（ESD）是一种有效切除早期 Barrett 肿瘤的技术，与传统的 EMR 相比，它具有整块切除和准确的癌症切除边缘组织病理学分析的优势。然而，其较长的学习曲线和较高的不良事件发生率限制了它在西方的应用。我们旨在分析 ESD 切除复杂 Barrett 肿瘤的安全性和有效性。主要终点是整块切除和 R0 切除率。
这是对 2008 年至 2016 年 3 家三级转诊中心进行的 143 例 Barrett 肿瘤 ESD 的回顾性分析。
平均病变大小为 31.1mm（范围 5-90mm），中位随访时间为 21.6 个月（四分位间距 11.0-32.6 个月）。共有 24.5%（35/143）的病变在先前的内镜切除、手术或放疗后有疤痕。在本系列中，整块切除率为 90.8%，R0 切除率为 79%。总的不良事件发生率为 3.5%（1.4%出血，0%穿孔，2.1%狭窄形成）。扩大的根治性切除率为 65.8%，反映了 R0 切除率和更晚期疾病的比例。黏膜下癌被认为是影响 R0 切除率的一个显著因素。
我们在西方证明了 ESD 切除复杂 Barrett 肿瘤的可行性和安全性，包括大的、结节状或有疤痕的病变。对于经验丰富的操作者来说，这是一种安全有效的技术，不良事件发生率低。一旦完成 30 例手术，整块切除率就达到了一个平台。
