Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan; Department of Gastroenterology, Saku Central Hospital Advanced Care Center, Nagano, Japan.
Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan.
Gastrointest Endosc. 2017 Sep;86(3):533-541. doi: 10.1016/j.gie.2017.01.037. Epub 2017 Feb 4.
A "skirt" is a slightly elevated flat lesion with wide pits occasionally observed at the margin of laterally spreading tumors (LSTs). However, the endoscopic treatment outcomes of LSTs with skirts have not been clarified. The aim of this study was to evaluate the endoscopic treatment outcomes of LSTs with skirts.
Between February 2006 and March 2014, 996 LSTs were retrospectively examined to assess the clinicopathologic characteristics, procedure time, en bloc resection rate, R0 resection rate, adverse events, and local recurrence rate of endoscopic submucosal dissection (ESD) and of endoscopic resection.
Endoscopic treatment was performed in 35 cases of LSTs with skirts (ratio of ESD to endoscopic piecemeal mucosal resection [EPMR], 32:3) and 961 cases of LSTs without skirts (ratio of ESD to EMR to EPMR to polypectomy, 381:275:114:191). LSTs with a skirt were associated with a significantly higher recurrence rate (P < .01). In both ESD and EPMR, LSTs with a skirt were associated with a higher recurrence rate when compared with LSTs without a skirt (odds ratio, 12.7; P = .032, and odds ratio, 12.3; P = .061, respectively). Multivariate analysis demonstrated that the presence of the skirt and piecemeal resection were significant predictors of local recurrence.
LSTs with skirts had a significantly higher local recurrence rate after endoscopic treatment compared with LSTs without skirts, especially after EPMR. Therefore, ESD should be recommended as an endoscopic treatment for LSTs with skirts to minimize local recurrence.
“裙边”是侧向扩展型肿瘤（LST）边缘偶尔出现的轻微隆起、平坦病变，伴有宽的凹陷。然而，“裙边”LST 的内镜治疗效果尚不清楚。本研究旨在评估“裙边”LST 的内镜治疗效果。
回顾性分析 2006 年 2 月至 2014 年 3 月间 996 例 LST 患者的临床病理特征、操作时间、整块切除率、R0 切除率、不良事件及内镜黏膜下剥离术（ESD）和内镜切除术的局部复发率。
35 例“裙边”LST 患者接受了内镜治疗（ESD 与内镜分片黏膜切除术[EPMR]之比为 32：3），961 例“无裙边”LST 患者接受了内镜治疗（ESD 与 EMR 与 EPMR 与息肉切除术之比为 381：275：114：191）。“裙边”LST 与较高的复发率显著相关（P <.01）。ESD 和 EPMR 中，与“无裙边”LST 相比，“裙边”LST 均与更高的复发率相关（比值比，12.7；P =.032，和比值比，12.3；P =.061）。多变量分析表明，存在“裙边”和分片切除是局部复发的显著预测因素。
与“无裙边”LST 相比，“裙边”LST 内镜治疗后局部复发率显著升高，尤其是在 EPMR 后。因此，应推荐 ESD 作为“裙边”LST 的内镜治疗方法，以最大限度地减少局部复发。
