内镜黏膜切除术治疗高级别上皮内瘤变和黏膜内癌：加拿大的经验
Endoscopic mucosal resection for high-grade dysplasia and intramucosal carcinoma: a Canadian experience.
作者信息
Yamashita Denise Tami, Li Chao, Bethune Drew, Henteleff Harry, Ellsmere James
机构信息
From the Division of General, Surgery, Dalhousie University, Halifax, NS (Yamashita, Li, Ellsmere); and the Division of Thoracic Surgery, Dalhousie University, Halifax, NS (Bethune, Henteleff).
出版信息
Can J Surg. 2017 Apr;60(2):129-133. doi: 10.1503/cjs.013515.
BACKGROUND
Endoscopic mucosal resection (EMR) is increasingly being used as a first-line treatment for Barrett esophagus (BE) with high-grade dysplasia (HGD) and intramucosal adenocarcinoma (IMC). We reviewed our experience with endoscopic treatment of BE with HGD and IMC at our institution with respect to eradication rates, complications and long-term recurrence.
METHODS
We performed a single-centre retrospective review of all patients referred between October 2010 and August 2014 for EMR with dysplastic BE or IMC. We performed EMR using a cap-fitted endoscope, and the procedure was repeated every 3 months until eradication or progression of disease.
RESULTS
A total of 28 patients were identified: 16 with dysplastic BE (14 HGD, 1 low-grade dysplasia, 1 intermediate dysplasia) and 12 with IMC. Complete eradication of HGD was achieved in 11 of 14 (79%) patients. Three of 12 (25%) patients initially referred with suspected IMC were found to have invasive adenocarcinoma on EMR. Eradication was successful in 8 of 9 (89%) patients with true IMC, with 1 patient progressing to salvage esophagectomy. Complications occurred in 2 of 28 (7%) patients; both had esophageal strictures managed with dilatation. Median duration of follow-up was 371 days.
CONCLUSION
Our experience supports the safety of EMR as a first-line treatment for patients with BE with dysplasia and IMC in early short-term follow-up.
背景
内镜黏膜切除术（EMR）越来越多地被用作治疗伴有高级别异型增生（HGD）和黏膜内腺癌（IMC）的巴雷特食管（BE）的一线治疗方法。我们回顾了我院对伴有HGD和IMC的BE进行内镜治疗的经验，包括根除率、并发症及长期复发情况。
方法
我们对2010年10月至2014年8月间因异型增生性BE或IMC而转诊接受EMR的所有患者进行了单中心回顾性研究。我们使用带帽内镜进行EMR，每3个月重复该操作，直至疾病根除或进展。
结果
共确定了28例患者：16例为异型增生性BE（14例HGD、1例低级别异型增生、1例中级异型增生），12例为IMC。14例患者中有11例（79%）实现了HGD的完全根除。最初因疑似IMC转诊的12例患者中有3例（25%）在EMR时被发现患有浸润性腺癌。9例真正的IMC患者中有8例（89%）根除成功，1例患者进展为挽救性食管切除术。28例患者中有2例（7%）发生并发症；均为食管狭窄，通过扩张治疗。中位随访时间为371天。
结论
我们的经验支持在早期短期随访中，EMR作为伴有异型增生和IMC的BE患者的一线治疗方法是安全的。
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